Wound bed appearance with a wound vac?

Been there,done that, ASN, RN · Aug 28, 2014

Sounds like the wound vac is doing it's job, removing the dead tissue.

However, you have a concern regarding a complicated healing process. Get a message to the surgeon to be on the safe side.

kathleenweels · Sep 4, 2014

Sounds like the wound vac is doing it's job, removing the dead tissue.
However, you have a concern regarding a complicated healing process. Get a message to the surgeon to be on the safe side.

Thank you!! I appreciate the feedback.

mariebailey, MSN, RN · Sep 4, 2014

I would ask the clinician. Here's a link to a free course I did that may interest you: https://members.nursingquality.org/NDNQIPressureUlcerTraining/Module1/Unstageable1.aspx

Did it look like this?

K+MgSO4, BSN · Sep 4, 2014

Talk to your educator about getting the rep from the company to come and do some education. They love to teach new people, plus most of them were nurses at one point.

Been there,done that, ASN, RN · Sep 4, 2014

So much for the pizza I was eating.

olive11 · Sep 9, 2014

Slough is easy to remove using a q-tip. It's stringy, usually yellow in color, and won't "stick" to the wound. If it doen't come up easily, even after rinsing the wound with sterile saline, then it may be adipose tissue and should be left alone. Go to www.kci1.com and click on the education link. There are videos, photos, and docs with full training on there for each type of VAC.

Most wound VAC companies do NOT have nurses working the field anymore as reps due to cost constraints. Although the reps, territory managers, and such are well trained, they are not nurses. You can find nurses "in-house" when you call the 1-800 number for KCI and when the nurse calls the agency/clinic/office for wound care updates. I recommend talking with them. They are highly trained, have constant updates, and are happy to talk with you about your concerns. Good luck!

mrosette · Sep 17, 2014

Look at the wound: if you assess more than 60% yellow slough then vac is not appropriate tx for wound. Needs more vigorous cleaning before vac will do its job. Alert physician and ask for another tx till they can see. My humble experience... CWOCN since 2012, many vacs since then. Good luck!

CWONgal · Nov 15, 2014

Slough isn't always easily debrided with CTA's, ergo the term "adherent slough".

CWONgal · Nov 15, 2014

Effective Management Strategies for Negative Pressure Wound Therapy | WoundSource

This is a good article discussing NPWT and slough within the wound bed. It also mentions the use of a collagenase in combo with NPWT which I hear is used more and more now (haven't done it personally).

Davidaugustyn · Nov 17, 2014

Ok, to give you some clarified data.

Most times A WOUND VAC IS NOT TO BE USED IN A WOUND WITH SLOUGH.

To word this right, a wound vac is used to pull up granulation tissue and cannot do that with slough in the wound bed. It sounds like you already know this.

On that note, I have had many surgeons request them for BKA, AKA, Abd and other surgical sites to keep the area more approximated, collect the drainage, and keep a sealed contained environment. BUT I have NEVER seen it work well. Usually the VAC is discontinued after a week when the wound declines.

Here are the typical steps I see for a deep wound with adipose that is not surgically approximated:

Surgeon says wound vac it to keep it approximated

works for a time but then the adipose turns to fatty necrosis

Wound vac comes out for a period of further surgical and other forms of debridement (of fatty necrosis)

Scar tissue granulation fills as necrosis debrides. (Don't forget wounds heal from the inside out! Nutrition on board!)

slough is finally gone and the vac goes back on.

To get back to your topic. You have stated "dehisced" and "slough or yellow"

That tells me a few things.

-I have found that leg amputations often have a tendency to "slough up" You may be dealing with a wound that was fully cleaned out but is starting to form more necrosis. Often from further deterioration of an already compromised vascular system.

-If the wound bed was clean, this may also be adherent drainage. If it can be rubbed off (and don't be afraid to get a gauze and scrub unless it bleeds) that I would consider it good and VAC it back up.

-If there is slough in the wound bed, I would not VAC it. This is a matter of opinion, but if there is slough, I have always seen it needing to come out. You can sometimes get away with granulating over tendon or fascia.

I agree with CWONgal. Slough is usually NOT easily removable. In fact, it hardly ever IS.

To clarify, a wound VAC is NOT used for debridement. It is not used and does remove dead tissue.

Any other questions don't hesitate to msg me.

CWONgal · Dec 3, 2014

Several other observations. I don't think the silver granufoam is all that and a bag of chips. Personal experience is it seems to trigger an increase in debris.

Also, when you have a compromised limb multiple layers of drape (people either don't have experience or go overboard thinking a little bit more is better) can cause a deterioration in the extremity....have seen volatile feet where TMA's and/or wounds have been debrided and then the layers of drape caused increased moisture beneath and caused more damage requiring even more debridement.