Wound VAC and Granulation Tissue

[albertsm]

I have been on a wound vac for approximately 3 weeks. After the first application and change (2 days) at the hospital with direction from a KCI rep, the wound looked great with a lot of granulation tissue visible. Since then I am not seeing much (if any) granulation tissue durring dressing changes. I am going to a wound clinic a couple of times a week for changes and I have some questions. My wound was originally 5.5 cm x 2.5 cm x 2.5 cm

1. Should granulation tissue generally be visible througout the healing process or is this typically only seen early on?

2. The nurses that have been changing my vac seem to push the excess sponge (1-3 cm above surface) into the wound and they apply the drape. From what I've read the sponge should be placed gently into the wound and not forced. Is this true and could this be the reason I am not seeing as much granulation tissue durring vac chages?

I'm a little concerned because my doctor initially estimated 3 weeks to heal and I still have a ways to go. When I first got the vac I was very impressed with the healing from just the first 2 days. I have not been as impressed with my progress since going to the wound clinic and was wondering if their way of applying the sponge (forcing the excess in) is not ideal. The wound is a little less than half of its original size after 3 weeks.

[girasol56]

I have been on VAC for two weeks and feel similarly disheartened

[GmaC13]

You are right there actually shouldn't be "excess" sponge. The sponge should be cut to fit. I am currently caring for 3 pts with wound vacs. I was trained to cut the sponge to fit the wound as close as possible and when in doubt slightly small is better than sightly big. There are other factors that affect your healing. Are you eating enogh protien? You need 1.5 gm per kg of body wt. I always encourage my pt to increase thier protien intake to assist with granulation and have seen great results. Best of luck.

[hello101]

I am a wound specialist and a practitioner. I see a lot of people doing wound vac applicaton wrong...like "stuffing" the foam. I should be cut to fit. Does your wound have any undermining or tunnelling? How much drain are you having? It's not infected? There's a lot of questions to be ask...If wounds are stalling than you must look at the WHY questions. If you don't see wound progression in 1-2 weeks than you must reassess and do other wound care. With a wound vac, and if it's healing the way it should than yes you should see progression of granulation tissues. I have many patients who fail with wound vac and there are numerous reasons why...and always other alternative treatement (I'm saying it's going to be easy, but there is almost always other ways of doing things). I work in a wound clinic...which I hope that is where you are going to..someone who is specialized in wound. Not all physicians know the latest and greatest products out their. It is truely a specialty area. Good Luck.