Quick Case: Vacuum Therapy After Skin Grafting

By: Dr. J. Gnanaraj, Mr. L. R. Bravin, Mr. Wise Jacob, Ms. J. Regina Jeyaseeli and Mr. Tamilvannan M

BACKGROUND

Negative Pressure Wound therapy [NPWT] has been in use since the early nineties for treating non healing wounds. It decreased the edema, improves circulation and neo-vascularization, granulation formation, etc., and thus greatly improved wound healing. However the commercial machines are expensive and we devised various ways of low cost technology and machines for delivering the vacuum therapy.^{1, 2, and 3}

The low cost machines have been used for salvaging diabetic foot⁴, for treating post operative non healing wounds¹ and for Fournier’s gangrene.⁵ We describe how we used it after skin grafting.

THE PATIENT AND METHOD

The details of the patient are available in a previous article in mdCurrent-India.⁶ This patient came with extensive gangrene and with septicemia and improved dramatically with vacuum therapy. Since the wound was extensive and still had infection and muscles were exposed without granulation tissue over it the plastic surgeons were not keen to do skin grafting.

However extensive skin grafting was carried out as the patient was poor and could not afford to stay for a long time at the hospital away from their home town. The regular skin graft dressing was removed after two days as the smell from the wound was terrible and changed to the vacuum dressing [Figure 1]. Removing the vacuum dressing after seven days showed that the skin graft had taken well thanks to the vacuum dressing [Figure 2]. The addition of vacuum therapy after skin grafting has been tried since 2007.⁷

Dr. J. Gnanaraj MS, MCh [Urology], FICS, FARSI, FIAGES is a urologist and laparoscopic surgeon trained at CMC Vellore. He has been appointed as a Professor in the Electronics and Instrumentation Engineering Department of Karunya University and is the Director of Medical Services of the charitable organization SEESHA. He has a special interest in rural surgery and has trained many surgeons in remote rural areas while working in the mission hospitals in rural India. He has helped 21 rural hospitals start minimally invasive surgeries. He has more than 150 publications in national and international journals, most of which are related to modifications necessary for rural surgical practice. He received the Barker Memorial award from the Tropical Doctor for the work regarding surgical camps in rural areas. He is also the recipient of the Innovations award of Emmanuel Hospital Association for health insurance programs in remote areas and the Antia Finseth innovation award for Single incision Gas less laparoscopic surgeries. During the past year, he has been training surgeons in innovative gas less single incision laparoscopic surgeries.

Mr. L. R. Bravin, B.Sc Nursing, has been an RN for 13 years and has had special training in advanced cardiac life support and wound management. He is interested in participating in programs with innovative concepts for the development of healthcare related to nursing and humanity.

Mr. Wise Jacob is a male nurse working with SEESHA karunya Community Hospital and was trained at CMC Vellore. Mr Jacob has additional qualifications in nurse administration and computers and has a special interest in wound management.

J. Regina Jeyaseeli, Bsc Nursing. She has 15 years experience in teaching and clinical field work. At present she is working as a Nurse-In-Charge at Seesha Community Hospital in Coimbatore.

Tamilvanan M is a Staff Nurse working in SEESHA and graduated from CMC Vellore. Having 10 years of experience in various areas like OT, General Medicine, Leprosy and DM managements.