Consider using these steps (listed in the KCI VAC Therapy Clinical Guidelines) when attempting to close flaps with the assistance of VAC therapy.
1. Suture the flap in place using about a third fewer sutures than usual. The greater spacing will allow V.A.C.® Therapy to remove fluid through the suture line.
2. Place a single layer of V.A.C.® Drape or other semi-occlusive barrier, such as a hydrocolloid dressing or vapor-permeable adhesive film dressing, over the intact epidermis on top of the flap and on the opposite side of the suture line. Place a single layer of wide-meshed, non-adherent dressing over the exposed suture line.
3. If the recipient bed is exuding heavily, cut a thin strip of V.A.C.®WhiteFoam Dressing and place it under the flap, between the sutures, to wick fluid from the interior of the flap. Make sure the V.A.C.®WhiteFoam Dressing and V.A.C.® GranuFoam® Dressing communicate directly.
4. Select an appropriate size of V.A.C.® GranuFoam® Dressing to cover the entire flap, including the suture line and 2-3cm beyond the flap. Ensure the area covered by the foam is protected intact skin (Step 2).
5. Prepare and apply the V.A.C.® Drape over the foam, according to Step 4 of Dressing application technique (p. 19). Apply a SensaT.R.A.C.®/T.R.A.C.® Pad and connect to canister tubing.
6. Initiate therapy on continuous setting.
7. Removal of the V.A.C.® Drape requires lateral stretch (pull) on the drape to prevent lifting of the flap.
KCI, 2009. V.A.C. Therapy Clinical Guidelines retrieved from http://www.kci1.com/Clinical_Guidelines_VAC.pdf
Matthew Livingston R.N. C.W.S.
