Woundvac help!

[kansasredneckwomen]

I was able to see another woundvac demonstration today. This was, by far, the worst wound I have ever seen (to the point our instructor continually assessed us for dizziness and nausea)! The client had gotten his upper arm caught (on what I am not sure) after a fall and was unable to get to his phone for 24 hours. The extensive damage apparently causes massive edema so they had to cut his arm open to drain. He now has a wound on his forearm starting at his elbow and extending clear to his wrist. It is approximately 9 cm wide. It exposes his muscles, tendons, and ligaments. When they reapplied the foam, they left about 1 cm uncovered by the foam. I was always told that the entire wound had to be covered with foam or tissue damage could occur. They told me that the negative pressure would suck it up and press it against the adjacent foam. Is this correct or are they mistaken? I am asking because we had a demonstration by one of the individuals that helped invent the woundvac and am pretty sure he said all tissue must be covered by foam or a protective dressing to prevent damage. Thank you!

[nurseprnRN, BSN, RN]

Were you able to see how it looked after they completed re-dressing it and reapplied the suction? Did that bring the sponge over the exposed tissue? or not?

[tokebi]

I've never seen an wound edge get sucked and pressed against the foam that's cut smaller. I've felt that it fits perfectly if I cut the foam a couple millimeters larger than the wound (cut the foam slanted so that the surface in contact with the wound is smaller than the surface flush with the skin). Maybe that particular wound is unique and does fit into the smaller foam, I don't know...

If any part of the wound is not covered by the foam but in direct contact with the film, that part would not get suction nor would it benefit from the micro-environment of the foam that helps tissue regeneration.

Here's a video by KCI that helped me a lot understanding how it works. I think it demonstrates why all wound surface should be covered well.

http://www.youtube.com/watch?v=88XHwSty9jw&feature=related

[merlee]

The foam should fill the wound/cavity, and the film should protect any intact skin. I have seen some huge wounds shrink down in amazingly short periods of time. And I once had a patient who developed comparment syndrome in BOTH forearms at the same time, and we were able to 'Y' the two sites into one suction system.

I have seen fist-deep decubs over trochanters, with tunneling and undermining, heal completely, leaving only small puckered scars.

And others I don't wish to describe.

If there is a really small spot on an edge, say smaller than your pinky fingernail, well, maybe that's okay. But mostly, the foam should completely fill the cavity.

Best wishes!