I do home care and right at this moment I have 4 pts that I see with the vac, (we have 12 going in our office at present) One on the abdomen, and one on a BKA site,(this one started out on the foot, but was the wound was too far gone before the pt finally went to the MD) I have been using the vacs since they first started coming out in the home back in the early-mid 90's. I have seen very good results depending on the patient. If the pt is not compliant, or has other major health problems, you run into issues. I have had a pt who was a diabetic, who just did not want to cooperate. Within 45 min of us putting the vac on, she was turning it off. She would leave the dressing on, put the pump itself was off........ you can only imagine what we would find when we went back 48 hrs later. We did have one man who had a hip replacement that wound up with problems. His incision was the length of his thigh, and about 10cm deep. We placed the vac on him and approx 3 months later it was closed. It took a little longer on him, he was diabetic as well. Seen one lady who the vac closed an abdominal incision in 3 wks.
The seals can sometimes be a problems as others have stated. I have used duoderm under the dressing, lots of skin protectant, ostomy paste, opsite or tegaderm..... and unfortunately in home care, you dont have the luxury of 2 people to place a vac. Its just me, myself and I. So you become creative.
We also dont have a KCI rep come to the home anymore. There are 3 of us who have been dealing with vacs for many yrs so we do pretty much all the vacs. We do have an ET nurse that if we run into a problem, we call her. We ran into problems with the reps not knowing how to place the vac on, or being rude, or just not "having time" to come to a home. So once the vac is ordered and delivered, the nurses take it from there.
Just as a side note, in home care, we have some physicians who have seen the demo, and decide to order the vac. Some pts are appropriate, some are not. Some of the physicians dont know exactly how it works, or even how to place one. I have had to go to the physicians office during the pt appt and place the vac on so the physician could see what it involved and explain it to them. Needless to say, whenever that physician wanted one placed, he called me to ask if it was appropriate. :chuckle