37.6 Vacuum-assisted closure* instill as a method of sterilizing massive venous stasis wounds prior to split-thickness skin graft placement      

JC. Lantis, MD; L. Tyrie, MD; C. Gendics, MD; G. Todd, MD; St. Luke's, Roosevelt Hospital, New York, NY     

Introduction: Patients with massive venous stasis ulcers that have very high bacterial burdens represent some of the most difficult wounds to manage. The vacuum-assisted closure* (VAC) device is known to optimize blood flow, decrease local tissue edema and facilitating the removal of bacteria from the wound bed. However, these patients have too high a bacterial burden for simple VAC application to facilitate all these functions. We present the application of the VAC with instillation of dilute DakinÕs solution as a way of bacterial eradication in these patients.

Methods: Over 2 years, 5 patients with venous stasis ulcers greater than 200 square cm that were colonized with greater than 105 bacteria were treated with the VAC instill. Two patients had multi drug resistant pseudomonas, 3 with MRSA. All patients were treated with 10 days of VAC instill therapy with 12.5% DakinÕs instilled for 10 minutes every hour. At 10 days all 5 patients underwent quantitative culture prior to undergoing STSG, which was matured under a VAC.

Results: All 5 had negative quantitative cultures, after 10 days of therapy. All 5 of the STSGs had 100% take with complete healing still evident at 1 year.
 
Discussion: Adequate delivery of bactericidal agents to the infected tissue can be very difficult, especially while promoting tissue growth. By providing a single delivery system for a bactericidal agent for a short period of time followed by a growth stimulating therapy the VAC instill provides a unique combination that appears to maximize wound bed preparation.

*VAC Instill, KCI, San Antonio, Tex