Here - EWMA 2013

POSTER: EDUCATION
Poster: Dressings
P 591
AUDIT OF THE USE OF VACUM ASSISTED CLOSURE (VAC) IN SKIN GRAFT: THE
IDENTIFICATION A PATIENT GROUP AT HIGHER RISK OF GRAFT LOSS
Jeong Tae Kim 1
1
Department of Plastic and Reconstructive Surgery College of Medicine, Hanyang
University (Seoul, Korea).
Introduction: Vacum assisted closure (VAC) has been increasingly used as a dressing
with split skin graft with reports confirming improved rate of take following its use. This
could be attributed to its role in hematoma or seroma evaculation and reduction of
shearing pressure by providing a splinting effect of the graft on its bed. This audit
examine the use of VAC systems in skin grafting in a consecutive case series.
Methods: From March 2009 to February 2012, 28 consecutive patients underwent
split-thickness skin grafts SSG and vacuum assisted closure dressing (V.A.C.).
Kinetic Concepts, Inc., San Antonio, Texas). Negative pressure was 125mmHg
continuous. 16 patients had no underlying disease. 12 patients had peripheral vascular
disease. After lesion debridement a 12/1000 inch skin graft was harvested by Electronic-
Dermatome (Zimmer, USA) and fixed to the recipient site with staples. Graft check was
made on the 5th day post procedure. A photograph was taken and the the percentage of
graft take was estimated by two clinicians with the mean of the two estimates being
recorded as the outcome measure.
Results: In the 16 patients with no comorbidities, one patient had partial graft loss. This
went on to heal by conventional dressing after 1 weeks. In the 12 patients with
peripheral vascular disease, 3 patients showed partial or total graft loss. Two of these 3
patients had systemic lupus erythematosus( SLE) and one patient had arteriosclerosis
Obliterans (ASO). A second SSG was applied to two of these three cases and one of the
two patients with SLE suffered from a second total graft loss. The defect went on to heal
by conventional dressing one month post procedure. The total skin graft take was 93%.
Discussion/Conclusions: Vacuum assisted closure is an effective dressing therapy
with skin-grafts is good way to reduce complication and increase the take rate of graft.
However, patients with peripheral vascular and connective tissue disease may be at
higher risk of graft failure with the use of this technology. We recommend communicating
this higher risk to these patients as part of the informed consent procedure. It would be
prudent to investigate any confounding role of the VAC therapy on graft take in such
vulnerable group.
P 292
Poster: Education
DEVELOPMENT OF A TRAINING AND TREATMENT ACADEMY TO IMPROVE
CHRONIC OEDEMA MANAGEMENT IN THE COMMUNITY: A NEW PERSPECTIVE
Rebecca Elwell 1 , Rachael Sykes 1
1 University Hospital of North Staffordshire NHS Trust (Stoke on Trent, United Kingdom).
Aim: This model aims to bridge the gap between initial specialist assessment and
implementation of patient care. Chronic oedema is tissue swelling present for three
months, commonly caused by uncontrolled venous disease, impacting on lymphatic
function. Timely assessment and intervention are essential to achieve long-term positive
outcomes.
Methods: Traditional models in the U.K. involve referral to a hospital specialist, where
following assessment and correct diagnosis compression bandaging is often indicated.
The aim being to achieve oedema reduction and re-shaping prior to maintenance with
hosiery. Previously, if bandaging, was required there was a delay between intervention
allowing for training. Delays can lead to further disease progression, impacting on
treatment(*).
Cohesive short stretch bandages are recognised as the most appropriate for chronic
oedema, they have a massaging effect on the tissues whilst preventing trauma and
slippage. Often inappropriate bandage selection and technique can lead to further long
term problems for the patient(**).
Results: An honorary contract in partnership with industry has been utilised, to ensure
training and treatment are provided to the highest standards in the most cost-effective
manner. The honorary contract nurse will see the patient in the community with their
community nurses. The benefits are multi-faceted, an emphasis is placed on shared
care, there is less opportunity for misinterpretation of treatment plans and importantly,
training can occur during initial appointment.
Conclusions: This model of chronic oedema care aims to ensure that treatment is
provided to the highest standards in the most cost-effective manner.
* Bianchi et al, 2012
** Williams 2009
EWMA 2013
COPENHAGEN
15-17 May · 2013
Danish Wound
Healing Society
175