Case Study: V.A.C ® therapy management of a complex ventral abdominal wound

Miss Kelly Vickers1
1Lyell McEwin Hospital, Elizabeth Vale, Australia

Introduction: Vacuum Assisted Closure (V.A.C®) Therapy has become a common wound care practice used in the treatment of surgical wounds, ulcers, skin grafts, burns, diabetic feet & fistulae. With its increasing use, particularly on complex wounds, clinicians sometimes need to adjust how it is used to ensure a positive patient outcome is achieved.

Background: A 65- year old female required a Hartmanns Procedure for a colovaginal fistula secondary to a diverticular perforation.  Complications such as a retracted stoma, wound breakdown and intra-abdominal sepsis lead to a further five surgical operations, resulting in a large ventral defect beneath the open wound. Other factors such as obesity (BMI 36.6kg/m2) and leaking stoma appliances further complicated her management.

Method: The large, irregular surface area of the wound, meant that V.A.C ® therapy was the most ideal option to heal this wound, but the large ventral defect in the abdominal fascia limited the use of high-pressure V.A.C ®, for fear of causing an enterocutaneous fistula. Using clinical judgement, low pressure V.A.C® therapy was initiated.

This case study outlines the challenges encountered when using V.A.C.® Therapy at low pressure suction, and the solutions created for successful wound healing.

Conclusion: By adjusting the application of low-pressure V.A.C ® to this abdominal wound, dressing leakages were prevented and attended to every 48-72 hours on the ward instead of being completed in the operating theatres. Initially it was planned for the patient to have a skin graft to the wound, but the wound healed without this additional surgery.


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