V.A.C. VERAFLO™ Therapy with V.A.C. VERAFLO CLEANSE™ Dressing
Infected Sacral Pressure Ulcer
Dr. Bernardo Silva Abad
Silvia Abarca Wound Specialist Nurse
Hospital San Diego, Cuernavaca, Morelos, Mexico
A 35 year-old female presented with an infected sacral pressure ulcer after being bedridden for 15 days with dengue fever (Fig. 1).
The patient has had diabetes type 2 for 20 years, has end stage renal disease in hemodialysis and a Jehova witness (accepts no blood transfusion). The ulcer received into ample debridement in the operating room (Fig. 2).
Tissue cultures were positive to Enterococcus faecalis. Intravenous antibiotics were administered for 3 weeks. Post surgical hemoglobin was 4,9 mg/dl so further surgical debridement (with corresponding blood loss) of the infected tissue was no longer an option. (Fig 3.)
Three days after initial debridement V.A.C. VERAFLO Therapy using de CLEANSE Dressing was used with PRONTOSAN (B. Braun Medical AG, Sempach, Switzerland) as instillation solution (40 ml) with a dwelling time of 30 minutes every 6 hours with continuous negative pressure of -125 mmHg. (Fig. 4) An hidrocoloid dressing was used in the intergluteal space to avoid leaks. Dressing changes occurred every 4 days allowing 2 hours for the device to be shut off before the dressing removal so the tissue would not still be inside the CLEANSE dressing holes and reduce bleeding. Only minimal debridement was done in the patient´s bed for the tissue bled easily.
Until now 3 V.A.C. Veraflo CLEANSE Dressing changes and 4 conventional V.A.C. Therapy with silver sponges have been utilized with a 4 days interval between changes. (Fig. 5,6)
The wound is reducing in size, cultures are negative, granulation tissue is growing with no signs of clinical infection. (Fig. 7) V.A.C. Therapy will continue to be used until skin grafting can be possible.
Using de V.A.C. Veraflo CLEANSE Dressing allowed the wound to be effectively debrided without pain and without blood loss.
Surgical debridement in this case would have been costlier considering operating room time and blood transfusions and much more time consuming and painful.