Wound vac seal in toe space

[BabaLouRN]

I have a pt who had 2nd toe amputation and is on wound vac therapy. Anyone have any ideas how to get a good seal for the wound vac when the toe space is narrow and toes curled under ?

[meanmaryjean, DNP, RN]

Verrrrrrrrrrry carefully! :)

(Sorry, my daughter is the wound care person, not me.)

[kiszi, RN]

I've used strip paste around wounds like that with lots of skin prep, and have gotten pretty good results.

Of course you want to make sure to bridge the trac pad out to the top of the foot with drape underneath. Also, I have found that for small spaces like that, cutting the drape into thin strips and giving it a little stretch as you lay it over the wound helps with the seal as well.

[LDRNMOMMY, BSN, RN]

I would use a technique similar to what Kiszi describes.

[mommy.19, MSN, RN, APRN]

Good comments by Kiszi, I generally clean the skin extremely well, then pat dry. No sting skin prep, tincture of benzoin, or mastisol can be your best buddy when it comes to difficult vac seals. I personally like eakin cohesive rings on toe amp sites, paste can be a wet mess (unless that is all you have). I generally apply the prep agent, then the cohesive seal to the immediate wound margin, and then as Kiszi described, very thin strips of drape as well as bridging the TRACpad to the dorsal foot, making sure to put a thick foam cushion under the TRACpad as to not cause a bullae from not enough protection under the suction. Hope this helps!

[CWONgal]

Barrier rings, like Eakin work well when you conform them around the wound and in difficult crevices. (Besides feet the rings are helpful in areas within the gluteal fold where you tend to have moisture from sweating).They help prevent excess moisture on the skin and give you a nice base to fit your drape. Be careful not to use too much drape and don't place tape between the other toes in an attempt to secure the dressing. A lot of these folks have underlying circulatory issues and the excess drape can break down the skin further, despite using a skin sealant for protection. And like the others said you definitely want to bridge over onto the dorsum of the foot and ensure you have a bolster to protect from tracpad pressure.