WOUND BLOG by Matthew Livingston RN

Wound VAC  therapy is a useful method  for preventing surgical wound dehiscence in at risk patients.  Placing  negative pressure wound  therapy essentially helps stabilize both sides of the  suture line.  Patients who are appropriate for this technique include individuals with  multiple co-morbidities or surgical and post surgical complexities (including increased tension to the tissue incision edges, excessive edema, or  fluid accumulation).  The following steps can be used to achieve better outcomes for these at risk patients:

Leave the incision line and immediate skin exposed (to around a centimeter or two away from the incision line). Place a protective dressing past that centimeter with VAC drape, transparent film dressing, or a hydrocolloid dressing on the skin. This helps  protect the skin from the suction of the negative pressure.   Ensure that the protective dressing covers at least a 3-5cm border of periwound tissue on each side of the incision.

Lay a single layer of a wide meshed non-adherent material over the exposed incision line (including exposed skin, staples, and/or sutures) along with over the protective dressing. I prefer Conformant 2 Wound Veil (a Smith and Nephew product). Cover the non-adherent mesh with the foam* and drape. KCI Wound VAC Therapy guidelines recommend initiating therapy at 75 mmHg continuous and the dressing should be changed every 48 to 72 hours (KCI, 2007).

KCI, 2007. V.A.C. Therapy Clinical Guidelines retrieved from http://www.kci1.com/Clinical_Guidelines_VAC.pdf

*Note: That KCI V.A.C. Therapy Clinical Guidelines refer to preventing wound dehiscence with their reticulated foam dressing. No other company that provides NPWT systems provide literature to recommend or support the use of their foam or gauze kits in the prevention of surgical wound dehiscence .