WOUND BLOG by Matthew Livingston RN

Matthew…great blog and great wound info!! Tell me – what has been your experience with using VAC on a venous stasis ulcer? Any tricks for helping to keep the seal with the weeping? Also do you apply light compression over the VAC? I have never had a good experience with this and spend most of my time patching the seal,, but thought you might have some creative tips. I appreciate it…thanks so much!

A

Dear A, Great Question.  The first decision I make when choosing negative pressure (VAC) for venous etiology wounds is which types of venous wounds I would exclude. Limiting conditions or symptoms include:

1. Infection, or an inflammatory reaction along the periwound or the extremity itself.

Note: while infection of venous wounds does occur it is often mistaken as the lone cause of redness along the extremity or peri-area of the wound. More commonly, this redness (erythemia) is related to an inflammatory process common with venous wounds (see a great explanation below*). If this problem is preventing the application of Wound Vac therapy then I recommend a Medrol dose pack which typically does this trick in reducing the inflammatory process.

2. Fragile or weeping skin tissue proceeding from the borders of the wound out to the greater part of the lower extremity (disallowing adhesion of wound vac drape or duoderm thin without the further opening of wounds along the extremity).

This being said, you can treat fragile or weeping skin just a few inches away from the wound with a few simple tricks.

First, on outright weeping skin a recommend a layering process that starts with the application of Non-sting skin prep followed by anti-fungal powder.  Alternatively repeating (at least 10 repeated applications) the application of these two products achieves two goals as the weeping areas are covered in a way that limits their drainage and the skin prep provides a great tacky surface for which the wound drape to adhere.

Second, along the edges beyond the weeping or fragile skin tissue place a Duoderm thin (ConvaTec). I have found that Duoderm Thin is about the only dressing that prevents the fluid from working its way under it a high draining wound with or without NPWT.  I also recommend placing stoma paste (ConvaTec) in the trenches of skin that the Duoderm Thin can’t secure to (See the following image). Once hardened place the Duoderm Thin over the Stoma Paste.

Finally, at this point place the VAC Foam in the wound bed. I recommend the  the V.A.C.^® GranuFoam™ Bridge Dressing (See Picture Below). This dressing allows you to concisely weave the pre-sized bridge dressing through the multilayer compression dressing. When applying the wound drape place skin prep to skin (that is intact) and over the Duoderm Thin to provide a more wound drape dressing.

“Venous reflux (or valve failure) or other vein conditions can lead to increased pooling of blood, causing venous hypertension (increased pressures in the veins of the lower leg), which leads to the pooling of blood. These venous conditions may come from more superficial veins (like varicose veins), deeper veins (related to deep vein thrombosis or DVT) or from perforator veins, which connect the veins of the superficial and deep vein systems. When these high pressure conditions exist, fluid can leak out into the surrounding tissues, inflammation of the tissues occurs, and the normal transfer of nutrients and oxygen to the tissues is impaired. Over time, the diminished level of nutrients and oxygen and the inflammation created causes damage to the surrounding tissues, which can result in skin discoloration and tissue death” (retrieved from www.veintreatment.com).