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 Table of Contents  
CASE REPORT
Year : 2021  |  Volume : 7  |  Issue : 2  |  Page : 119-122

Use of hydrocolloid dressing to achieve seal in vacuum-assisted closure therapy in anatomically challenging regions


Department of Plastic and Reconstructive Surgery, Pondicherry Institute of Medical Sciences, Puducherry, India

Date of Submission20-May-2021
Date of Acceptance11-Oct-2021
Date of Web Publication30-Dec-2021

Correspondence Address:
Jonathan Victor
Department of Plastic and Reconstructive Surgery, Pondicherry Institute of Medical Sciences, Puducherry
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/jcrsm.jcrsm_40_21

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  Abstract 


In certain anatomical regions achieving seal in the VAC, dressing is challenging. Inadequate seal during VAC therapy can make the therapy ineffective and also leads to wastage of resources. The use of strips of hydrocolloid dressing around the wound can achieve seal when using VAC therapy in these regions. We present our clinical experience with a case series of four patients in whom this technique was used. Hydrocolloid dressings being easily available in most clinical settings and being cost-effective also, this technique can be a simple, readily available solution for a commonly encountered problem during VAC therapy.

Keywords: Hydrocolloid dressing, negative pressure wound therapy, seal in vacuum-assisted closure therapy, vacuum-assisted closure dressing


How to cite this article:
Victor J, Jaganathan V, Rao T, Lingam P. Use of hydrocolloid dressing to achieve seal in vacuum-assisted closure therapy in anatomically challenging regions. J Curr Res Sci Med 2021;7:119-22

How to cite this URL:
Victor J, Jaganathan V, Rao T, Lingam P. Use of hydrocolloid dressing to achieve seal in vacuum-assisted closure therapy in anatomically challenging regions. J Curr Res Sci Med [serial online] 2021 [cited 2022 Jun 28];7:119-22. Available from: https://www.jcrsmed.org/text.asp?2021/7/2/119/334458




  Introduction Top


Vacuum-assisted closure (VAC) therapy is being used widely for wound management for wounds in different regions of the body. VAC therapy is used to enhance the wound healing, decrease bacterial load, and remove the exudate from the wound.[1] In certain clinical scenarios such as contaminated wounds, polytrauma with patients who are hemodynamically unstable VAC therapy can be used to optimize the wounds before definitive cover. It is used for wounds in different regions of the body. In certain anatomical regions achieving seal in the VAC, dressing is challenging. Inadequate seal during VAC therapy can make the therapy ineffective and also leads to wastage of resources. The use of strips of hydrocolloid dressing around the wound can achieve seal when using VAC therapy in these regions. We present our clinical experience with a case series of four patients in whom this technique was used.


  case series' Top


Case 1

A 35-year-old male presented with a workplace injury by a machine crush injury to the right hand. There was degloving over the dorsum of hand and fingers. X-ray of the hand showed amputation at the level of proximal phalanx of all fingers. The wound was heavily contaminated, so after wound debridement and skeletal stabillization, a VAC dressing was applied. As web spaces in between the fingers made it an anatomically challenging region, strips of hydrocolloid dressing were used to achieve seal. The wound was then covered with groin flap [Figure 1] and [Figure 2]. After flap division surgery and subsequent physiotherapy, the patient could return to work by 4 months.
Figure 1: Machine crush injury of hand – Vacuum-assisted closure dressing applied

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Figure 2: Groin flap cover done

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Case 2

A 23-year-old male patient with a history of road traffic accident and crush injury of both the legs. X-ray showed bimalleolar fracture of the right leg. The fracture was stabilized with an external fixator. A VAC dressing needed to be applied to the soft tissue defect over the anterior aspect of the leg 15 cm × 8 cm. As the pins of the external fixator were within the wound, to maintain the seal, strips of hydrocolloid dressing were applied around the pins and around the wound margins. The VAC dressing effectively caused the wound to contract in size and subsequently, flap cover was done [Figure 3], [Figure 4], [Figure 5]. After subsequent orthopedic procedures, the patient could start weight-bearing ambulation by 6 months.
Figure 3: Bilateral leg crush injury with soft tissue defect

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Figure 4: Strips of hydrocolloid dressing to achieve seal around the pin of the external fixator in a leg defect

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Figure 5: Flap cover done following vacuum-assisted closure therapy

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Case 3

A 42-year-old female patient presented with sacral pressure sore following intensive care unit admission for 3 weeks with H1N1 pneumonia. The wound was heavily infected and had extensive muscle necrosis. Serial bedside debridement was done as the patient was a high-risk candidate for anesthesia. Wound culture showed heavy growth of Pseudomonas aeruginosa. Multiple sessions of VAC therapy were applied over a period of 6 weeks. To achieve a seal near the region of the gluteal cleft which is a common site of leak, strips of hydrocolloid dressing were used [Figure 6] and [Figure 7]. The VAC therapy was effective in achieving complete wound healing in 3 months without any further surgical intervention.
Figure 6: Strips of hydrocolloid dressing to achieve seal around sacral pressure sore

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Figure 7: Vacuum-assisted closure dressing applied for sacral pressure sore

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Case 4

A 23-year-old male presented with crush injury of the foot following a road traffic accident. There was a soft tissue defect over the dorsum of the foot exposing the extensor tendons and the metatarsal bones. When we applied a VAC dressing to the wound, we used strips of hydrocolloid dressing in the region of the web spaces to secure the seal. The wound granulated well with VAC therapy and could be covered with a skin graft. If VAC therapy had not been effective in this case, he would have required microvascular free flap transfer as the metatarsal bones and the extensor tendons were exposed in the wound.


  Discussion Top


VAC therapy has been used for managing wounds in various regions of the body.[2],[3] It has been used to promote granulation, decrease bacterial load, and optimize the wound before definitive wound cover. Frequent change of dressing places an increased financial burden on the patient and is labor intensive for hospitals. Achieving a good seal in VAC dressings can decrease the need for frequent dressing changes. Challenges in maintaining an airtight seal with VAC therapy can occur in regions with irregular surfaces (such as skin folds, scars, or curved surfaces), a humid milieu, or mobile structures. Achieving a good seal when applying a VAC dressing is a challenge, especially in complex wounds with external fixator pins coming within the wound. Often, leak alarms are set off by the leak at these pin sites. We used hydrocolloid dressing (DuoDERM® Dressings by Convatec) cut into strips and used it to achieve seal at the interface between the pin and the wound. Another common area of concern when using VAC dressings is the sacral pressure sore. Often, there is a leak reported in the region of the gluteal cleft. Applying strips of hydrocolloid dressing all around the sacral sore helps to achieve a better seal. When VAC dressings are applied over the hand or the foot, sometimes, a leak is reported through the region of the web spaces. Applying strips of DuoDERM around these wounds seems to solve this problem. After cleaning the wound, apply ether on the intact skin surrounding the wound and wait for it to dry completely, then apply the hydrocolloid dressing cut into strips. Any small amount of moisture in the interface between the skin and the hydrocolloid dressing can lead to improper seal. A single sheet of the hydrocolloid dressing can be cut into strips of 1.5 cms width. This is a simple cost-effective method. Greer et al. also in a case series used hydrocolloid dressings to achieve seal for VAC therapy with similar results as our case series.[4] Hydrocolloid dressing is readily available and is also a more cost-effective method to achieve seal.

There have been reports of use of other materials such as Coloplast paste, bone wax being used to achieve seal in VAC therapy.[5],[6],[7] Andrews et al. presented a study of 12 patients who had undergone negative pressure wound therapy (NPWT) of complicated head-and-neck wounds.[2] They achieved an airtight seal of the NPWT dressings using a combination of occlusive drape, Skin Prep, benzoin, and Tegaderm (3M Health Care, Inc, St. Paul, MN) on the surrounding skin. To achieve a VAC seal under high-humidity conditions, Jerome's guidelines and recommendations for use of NPWT include placing a hydrocolloid dressing around the wound.[8] Bookout et al.'s case series reports the use of stoma paste to fill in crevices to achieve an airtight closure.[9]


  Conclusion Top


The use of hydrocolloid dressing to achieve seal in VAC therapy is a simple and effective technique, especially in anatomically challenging regions. Hydrocolloid dressings being easily available in most clinical settings and being cost-effective also, this technique can be a simple, readily available solution for a commonly encountered problem during VAC therapy.

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Sinha K, Chauhan VD, Maheshwari R, Chauhan N, Rajan M, Agrawal A. Vacuum assisted closure therapy versus standard wound therapy for open musculoskeletal injuries. Adv Orthop 2013;2013:245940.  Back to cited text no. 1
    
2.
Andrews BT, Smith RB, Goldstein DP, Funk GF. Management of complicated head and neck wounds with vacuum-assisted closure system. Head Neck 2006;28:974-81.  Back to cited text no. 2
    
3.
Hsia JC, Moe KS. Vacuum-assisted closure therapy for reconstruction of soft-tissue forehead defects. Arch Facial Plast Surg 2011;13:278-82.  Back to cited text no. 3
    
4.
Greer SE, Duthie E, Cartolano B, Koehler KM, Maydick-Youngberg D, Longaker MT. Techniques for applying subatmospheric pressure dressing to wounds in difficult regions of anatomy. J Wound Ostomy Continence Nurs 1999;26:250-3.  Back to cited text no. 4
    
5.
Hendricks N, Hendricks J, Hoffmann K, Hemprich A, Halama D. Using medical silicone to ensure an airtight negative pressure wound therapy dressing seal in challenging wounds: A case series. Ostomy Wound Manage 2014;60:40-6.  Back to cited text no. 5
    
6.
Bulla A, Farace F, Uzel AP, Casoli V. Negative pressure wound therapy and external fixation device: A simple way to seal the dressing. J Orthop Trauma 2014;28:e176-7.  Back to cited text no. 6
    
7.
Caputo GG, Marchetti A, Governa M, Dalla Pozza E. A novel inexpensive technique to seal negative pressure wound therapy on external fixation devices. J Orthop Trauma 2019;33:e24-6.  Back to cited text no. 7
    
8.
Jerome D. Advances in negative pressure wound therapy: The VAC instill. J Wound Ostomy Continence Nurs 2007;34:191-4.  Back to cited text no. 8
    
9.
Bookout K, McCord S, McLane K. Case studies of an infant, a toddler, and an adolescent treated with a negative pressure wound treatment system. J Wound Ostomy Continence Nurs 2004;31:184-92.  Back to cited text no. 9
    


    Figures

  [Figure 1], [Figure 2], [Figure 3], [Figure 4], [Figure 5], [Figure 6], [Figure 7]



 

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