Dressing and debridement was made daily for 4 days till the wound showed some improvement. The wound was full of necrotic tissue with foul discharge. The left thigh showed a huge degloving area (50 × 70 cm) with a big cavity in the upper pole of the wound. After 3 weeks of dressing and serial debridement, the patient was transferred to our hospital. Then, the patient developed hematoma with skin necrosis over his left lateral thigh. The patient was treated at a district hospital conservatively. Most of the wounds were healed by secondary intention (6 cases) and three cases required skin grafts.Ī 17-year-old man weighing 157 kg sustained a trauma to his left lateral thigh. This maneuver converted the chronic wound into an acute wound. The policy was to debride the chronic wound before application of VAC. In addition, one patient suffered from chronically infected ulcers in gluteal area from fillers. Of nine chronic wounds, 8 patients had chronic diabetic ulcers. The pressure was adjusted to 125 mmHg with no necrosis to the enteric stumps. VAC was applied to protect the abdominal skin before closure of the fistula. The proximal segment was acting as high output fistula which results in severe maceration to the abdominal skin. The surgeons delivered the proximal and distal stumps out. One of them was 1-month old infant suffered from enterocolitis and resection was done to the gangrenous segment. The last subcategory of acute wounds was cases suffered from enterocutaneous fistula (2 cases). By adopting this technique, the general condition of the patient and the condition of the wound were dramatically improved. VAC was applied immediately after debridement to prevent future formation of pseudo eschars and necrotic membranes that might necessitate more debridement and consequently more morbidity to the patient. Necrotizing fasciitis was managed in four cases. In addition, there was a disrupted wound due to fracture pelvis with exposure of hardware. Those patients who suffered from gaped wounds were presented with opening of amputation stump ( n = 2), non-healing abdominal wound ( n = 2) and disrupted wound in lower leg due to non-healing power in chronically renal failure patients ( n = 2). All these cases were covered with skin grafts and excellent healing was achieved in 3 weeks' period. No mortality was recorded during this study.Īmong 19 acute wounds with co-morbid conditions, 15 suffered from diabetes, 2 from morbid obesity and 2 from chronic renal failure. The hospitalization period varied from 1 to 6 weeks. Once, the sponge was retracted, secured and there was no leak, the pressure was lowered to 125 mmHg. This maneuver was combined with elevation of the pressure to the maximum limit. To ensure sealing of the dressing, a pressure bandage was applied to the wound together with manual compression to get rid of any air space. The dressing was connected to the machine through tubing that was connected to the canister. A slit opening was never used as it might lead to blocking of the system. This would facilitate application of adhesive sheets without the need of an assistant especially in extremity wounds.Īfter putting one layer of adhesive dressing, a rounded or a rectangular opening was made in the center of the sponge. Then the sponge was applied and secured with 4 corner stitches of non-absorbable sutures. This was a very important step to guard against bleeding, pain and detachment of skin grafts during dressing. In regard to chronic wounds, the lesion was debrided to refresh the bed and the edges before application of VAC.Īll wounds were covered with one layer of non-adherent dressing. In cases presented with necrotizing fasciitis, VAC was applied immediately after debridement. In all acute wounds, VAC was used when granulation tissue started to appear in the wound except in necrotizing fasciitis. Patient exclusion criteria: small sized acute wounds with no co-morbid conditions, children when they start to crawl (7 months) till 5 years of age, mental disorders, wounds with persistent leak of fluids, perineal area with no colostomy, systemic sepsis, malignancy, and osteomyelitis. Acute wounds were involved in 19 patients with co-morbid conditions, 7 patients with gaped wounds, 4 patients with necrotizing fasciitis and 2 patients with enterocutaneous fistula. Nine patients had chronic wounds and the rest 32 had acute wounds. The mean age of patients was 29 years (range, one month–63 years). Separate consent for photography was taken from all cases included in the study. Informed consent was obtained from all parents responsible for participants included in the study. This study has been performed in accordance with the ethical standards set forth in the 1964 Declaration of Helsinki and its later amendments. From November 2012 to April 2015, 41 patients presented with acute or chronic wounds were included in this study.
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