Dear Editor:
This is in reference to the article: Leijnen M, et al. A Nonhealing Sinus of the Lower Leg 5 Years After Vacuum-assisted Closure Therapy Due To a Gossypiboma. WOUNDS. 2007;19(8):227–230. It should be noted by anyone using the KCI Wound V.A.C.® that KCI does not recommend placing black foam (GranuFoam™) in deep openings, undermined areas, blind areas, or tunnels. It is recommended that the white foam (Vers-Foam™), which is dense and has a higher tensile strength, be used for these areas. Also, when cutting the black foam to fit the wound, small pieces of the foam may be left in the wound if the cut part of the foam is placed against the wound surface. The wound must be examined carefully for retained pieces of the black foam and should be removed. Dorothy Blank, DPM
Ankle and Foot Centre of South Florida
Loxahatchee, Florida Dear Editor:
We are aware of the advice given by the manufacturer of the V.A.C.® materials. We agree with Dr. Blank that in specific kinds of wounds the use of the white, denser foam with smaller pore size is preferable to the use of the black foam. However, in our experience some wounds are treated insufficiently with the white foam—especially in wounds of large diameter and wounds that have a significant amount of debris. The pores of the white foam are more easily clotted with this debris resulting in more frequent bandage changes and higher expenses than when using black foam. Furthermore, in our experience tissue granulation rate is significantly higher when using the black foam, although there is no evidence to support this in literature at the present time.
We concur that thorough inspection of the wound cavity is important for identifying any missing pieces. We advise, as does Fox et al,1 to count and note the amount of pieces that are put into the wound when using V.A.C. therapy. Additionally, we suggest connecting separate pieces together, either by stapling or stitching. These measures can limit the retainment of foam but will never prevent it completely. There is no such thing as a perfect therapy. Our article merely suggests measures to minimize patient risk when using V.A.C. therapy where the wound is better treated using the black foam when the wound conditions, as stated above, are evident. Michiel Leijnen, MD, MSc Louk van Doorn, MA-NPA Jacques Oskam, MD, PhD
Rijnland Wound Clinic and Department of Surgery Rijnland Hospital
Leiderdorp, The Netherlands |
