Wound vac question/vent

[Nursetastic]

I'm a new grad with very little experience with wounds, so I have a situation that confuses me. Am I just experiencing newbie jitters or am I legitimately concerned? The nurse orienting me told me she'd never seen this before either but that couldn't hurt.

We had a patient come in today for wound care on both sides of her foot and her surgeon had placed a wound vac over sutures. She has MRSA in the wound, and possibly in the bone (all following arthrodesis over 6 mos ago), and has had numerous I&D's (including one a couple weeks ago, hence the sutures that are for some reason still there) and at one point the wounds were apparently gaping, deep, tunnelled and had "benefited" from the wound vac before. I've never seen a wound vac on top of sutures...is this something that you have seen before? The wound drains A LOT even through the sutures and when we removed the sponges it just drained like a faucet the whole time. Oh, and she is no longer on IV ABX, just oral bacitracin, so I'm sure the MRSA is still raging under those sutures.

I'm venting, so I'm sorry if my post is confusing. Wound care really fascinates me and this situation seems odd. The patient is followed by bother her ortho surgeon (at our clinic) and an Infectious Disease doc.

[HmarieD]

Wound vaccs are never placed over sutures.

Maybe they shouldn't be, but they are, indeed, placed over sutures.

[kkluczynski]

We had a lady recently where I work who had a vac placed over a hip replacement incision. I never had seen it either until then but I was told that its something surgeons are doing now in order to speed up the healing. It did work well and the incision healed nicely.

[kkluczynski]

The sponge wasn't sutured into the wound it covered the sutures helping remove excess drainage.

[Nursetastic]

I saw a KCI rep today. He confirmed that sutures can be covered by the sponge, but usually the doc will remove a couple to facilitate drainage. This is contraindicated if there is untreated osteomyelitis.

[GadgetRN71, ASN, RN]

OK, I asked one of the surgeons at work today if wound vacs could be placed over sutures..the answer was yes. Most of the time, they are placed into open wounds but they can be placed over sutures...many times they don't do tight suturing because it's not a final approximation.They might just throw some nylon interrupteds in there with gaps in between. Many of these patients go to multiple surgeries. These wound vacs can also help the healing of the incision site.

Not saying that you don't have some valid issues/concerns with your patient...just letting you know that wound vacs can indeed be placed over sutures.

Wound vacs are beautiful things..they are doing awesome things now with wound healing. I've also seen the results of hyperbaric chambers to speed up wound healing and it's astounding.

[RedhairedNurse, BSN, RN]

I saw a KCI rep today. He confirmed that sutures can be covered by the sponge, but usually the doc will remove a couple to facilitate drainage. This is contraindicated if there is untreated osteomyelitis.

I was just ready to respond to Webmansx post that said "Wound vaccs are never placed over sutures.", then saw your post.

I was reading the KCI website on indications for the wound vac and read exactly what you say here that wound vacs can be used on sutures but usually a couple of sutures are removed first.

Does this pt your talking about have a couple of sutures removed? And if not, were you able to speak with the doctor or wound care nurse, who ever placed this wound vac, to see what their plans are?

[kcicc]

KCI's wound vac is indicated for use over potentially compromised suture lines and is frequently used post TKR and THR. Ortho's in particular are fond of this application as they feel that it reduces the incidence of seroma as well as decreases or possibly prevents edema along the suture/staple line which further decreases tension on suture line. When applied perioperatively, you have a nice sterile dsg that is not usually be disrupted for 2-3 days post op. The application technique is discussed in KCI clinical guidelines, pg 27. (protect intact peri incision skin with KCI drape, single layer adaptic to suture line, apply Granufoam dsg as you normally would)

[BabaLouRN]

the negative pressure should actually BENEFIT with the sutures. The sutures are pulling the skin edges closer together to promote granulation. As long as there are no tunnels or undermining, the wound should close more quickly.

[HM-8404, BSN, RN]

I don't mean to derail this tread but I have a wound vac question. When is a wound vac not appropriate? In my last clinical there was a pt with the worst wound I have ever seen, and I have been in a trauma ICU. This pt has an open wound from about L3-L4 to his perineum, and from R iliac to L iliac, with everything exposed. When the dressing was removed I thought maybe this pt had been hit by a car and drug underneath it removing all of the flesh and most of the muscle tissue. I found out later it was a pressure ulcer that was not taken care of properly. The pt has an ascending colostomy and his colon is just hanging there like a hose.

The pt was A&O x3, helped with own care, etc. I got busy and never had a chance to ask why this pt did not have a wound vac.

[tyvin, BSN, RN]

Many times wound vacs are indicated but it's the insurance that stands in the way...especially if you have the patient at home. Maybe things have changed but it's my understanding that all the wound vacs are owned by 1 company and they don't sell them (show me the money!). So you have a monopoly. Many insurance companies will let patients go home with them but some don't. That's the reason I see that patients aren't put on wound vacs because they're at home and insurance won't approve.

[beckster_01, BSN, RN]

Would the patient have been stooping into the dressing frequently? As the previous poster mentioned, VAC's and their supplies are expensive, and if it would have to be changed frequently, or if it is going to be in a dirty area, then the coat-benefit isn't worth it. They are also indicated for healthy wound beds. Often they will be placed after debridment. But they won't do any good over eschar/slough.

[DookieMeisterRN]

I'm a new grad with very little experience with wounds, so I have a situation that confuses me. Am I just experiencing newbie jitters or am I legitimately concerned? The nurse orienting me told me she'd never seen this before either but that couldn't hurt.

We had a patient come in today for wound care on both sides of her foot and her surgeon had placed a wound vac over sutures. She has MRSA in the wound, and possibly in the bone (all following arthrodesis over 6 mos ago), and has had numerous I&D's (including one a couple weeks ago, hence the sutures that are for some reason still there) and at one point the wounds were apparently gaping, deep, tunnelled and had "benefited" from the wound vac before. I've never seen a wound vac on top of sutures...is this something that you have seen before? The wound drains A LOT even through the sutures and when we removed the sponges it just drained like a faucet the whole time. Oh, and she is no longer on IV ABX, just oral bacitracin, so I'm sure the MRSA is still raging under those sutures.

I'm venting, so I'm sorry if my post is confusing. Wound care really fascinates me and this situation seems odd. The patient is followed by bother her ortho surgeon (at our clinic) and an Infectious Disease doc.

I have seen vacs placed over sutures before. It sounds like this is not your typical patient and that other measures have failed in the past but it used to be that wound vacs were contraindicated for osteomyelitis. But there are atypical cases like this that may benefit from this treatment. The best people to ask would be the surgeon and/or ID doc!