Contaminated midline abdominal wounds are often left open and allowed to close by secondary intention to prevent surgical site infections. Negative pressure wound therapy (NPWT) devices have been shown to decrease time of healing by secondary intention when compared to the prior standard of moist dressings.¹ A modification of NPWT that utilizes the unique characteristics of the NPWT system to achieve a delayed primary closure while preventing surgical site infections by continuously draining the wound effluent is presented.

Materials and Methods
The proposed technique of NPWT, specifically vacuum-assisted delayed primary closure (VADPC), uses the same materials as the vacuum-assisted closure (V.A.C.^®Therapy^™, KCI, San Antonio, Tex). A commercially available kit (KCI) was used that included a polyurethane foam, tubing, and an adhesive drape. The suction pump was rented from KCI.
Proper wound selection is important for VADPC. The most appropriate wound for this technique is free of gross infection,devoid of necrotic debris, and has adequate perfusion. The patient’s nutritional status must be sufficient to promote new tissue growth. The VADPC is designed for simple, subcutaneous wounds. This technique is not appropriate for wounds with fascial dehiscence as the tension is applied only to the skin and would not provide fascial approximation. Wounds the authors have selected for this type of closure include: 1) laparotomy incisions with the skin left open following contaminated or dirty procedures; and 2) secondarily opened laparotomy wounds or cesarean section wounds resulting from a superficial woundinfection. This technique can be used in both thin and obese patients.
The skin around the wound is cleaned with an antiseptic and shaved if necessary. An adhesive solution is applied to the skin around the wound, and the adhesive drape is attached to one side of the wound and traction is applied to approximate the skin edges. This initial drape should extend at least 6 cm from the wound edge on each side. The adhesive drape is perforated with the tip of a scalpel every 2 cm to 3 cm along the length of the wound. The polyurethane foam is placed over the drape covering the entire length of the wound and extending out approximately 4 cm to 6 cm on each side, but not past the drape. Another adhesive drape is then placed over the foam covering the entire initial drape. The suction tubing is applied in the usual fashion. The pump is set to –125 mmHg of continuous suction. The dressing is left in place for 5 days to allow for tissue adhesion. After 5 days the dressing is removed parallel to the direction of the wound after releasing the suction to avoid pulling the skin edges apart. The dressing can be reapplied and any areas left open on the initial application can be approximated at this time. Alternatively, if healing is adequate, the dressing can be left off and the wound supported with Steri-Strips^™ (3M Health Care, St. Paul, Minn) to prevent dehiscence. A schematic view of the dressing application is shown in Figure 1.