A Simple Method to Prevent Vacuum-Assisted Closure Sponge Retention in Cavity Wounds

While few procedures are complication free, the safety profile of vacuum-assisted closure therapy for wounds has been good. Although rarely reported in the literature, the retention of foam in wounds following this therapy has caused complications. The authors present a technique to prevent foam retention and reduce wound morbidity due to tissue regrowth.

 Vacuum-assisted closure therapy has been considered revolutionary in chronic and acute wound care.¹ While very few procedures are complication free, the safety profile of this wound care therapy has been very good. A search in June 2014 of the US Food and Drug Administration Manufacturer and User Facility Device Experience database details 8 cases of retained sponge in the product class Negative Pressure Wound Therapy Powered Suction Pump.² The retention of foam in wounds is, however, rarely reported in the literature but has been known to cause complications.^3-5 The authors have devised a technique to prevent foam retention in the patient’s body from occurring while reducing wound morbidity due to tissue ingrowth.

  The inadvertent retention of a sponge in wounds treated with vacuum-assisted closure therapy has been reported to masquerade as osteomyelitis and nonhealing sinuses.^3-5 The authors frequently help manage complex wounds with deep openings, undermined areas, blind areas, tunnels, or bony cavities. The potential for retention of sponge pieces in these types of wounds was recently emphasized to the authors when a piece of sponge “finger” in a wound tunnel was torn off during a dressing change. In this case, the sponge was immediately noticed and removed, but the authors now recommend a new technique to prevent such mishaps and the significant complications that may arise from them.

  A thorough assessment of the wound is performed to ensure adequate debridement and to allow mapping of the topographical layout of the tissue defect. The next step is to carve or cut polyurethane black foam (V.A.C. GranuFoam, KCI, San Antonio, TX), white foam (V.A.C. Vers-Foam, KCI, San Antonio, TX), or a combination of both so that when stitched or stapled together (Figure 1) the material will fill the defect with some left to protrude for the chosen tubing, in the authors’ case SensaT.R.A.C. tubing (KCI, San Antonio, TX).

  This sponge-model of the wound is then covered in a mesh wound contact layer (Mepitel, Mölnlycke Health Care US, Norcross, GA) and stapled or stitched together (Figure 2). This construct is extremely tear resistant which prevents the sponge from separating and being lost. The contact layer also reduces tissue ingrowth and adhesion, thereby minimizing trauma and pain during its extraction. After this combination of sponge and mesh wound contact layer is placed in the wound, the dressing draping and continuous vacuum therapy may be commenced. As per the manufacturer’s guidelines for vacuum-assisted closure therapy, the authors recommend detailing the number and type of sponges used for the dressing in the patient’s medical chart. The authors also trace the sponge model onto the plastic coating for the mesh contact layer to use as a template for the next sponge dressing change.

  Using a mesh wound contact layer improves the structural integrity of the sponge model and, most importantly, ensures recovery of all of the sponge, regardless of type or the number of pieces. The mesh contact layer also helps minimize discomfort during dressing changes by reducing granulation tissue ingrowth of the sponge cells and excessive collapse at the mouth of the cavity wound.

Affiliations: Duncan Bayne, FRCS (plast), MRCS, MBBS, BDS, FDS, RCS is from the Department of Plastic Surgery, The Royal Hospital Haslar, Hampshire, United Kingdom. Niall Martin, FRCS (plast), MD, MRCS, MBBS, DMCC is from the Ministry of Defense, London, United Kingdom.

Address correspondence to:
Duncan Bayne
Queen Victoria Hospital Foundation Trust
Department of Plastic Surgery
Holtye Road
East Grinstead
West Sussex
RH19 3DZ UK
paperscorrespondence@inbox.com

Disclosure: The authors disclose no financial or other conflicts of interest.