Combination Hyperbaric Oxygen Therapy ( HBOT ) and Vacuum Assisted Closure ( V.A.C.®) Treatment in Complex Wounds

Complex trunk wounds are a challenge for the practitioner and devastating to the patient. Healing a complex wound requires expertise and commitment. By combining two complimentary modalities we have had achieved primary closure in the sternum, and successful locoregional flap reconstruction in an irradiated abdominal wound. We have treated 5 patients over a 12 month period with V.A.C. and HBOT. 2 sternal wounds, 1 radiation induced abdominal wound, and 2 fasciotomies. 2/2 sternal wounds healed primarily w/o further treatment, 1 radiation wound of the abdomen required a rectus muscle flap, all fasciotomies underwent skin grafting with 100% take. Although the use of combined HBO plus V.A.C therapy has been reported for healing fasciotomy(1) and perineal wounds (2), it has never been described for open sternums and other trunk wounds . In open sternums, the patients are often too ill to undergo flap surgery, this combined treatment may alleviate a return trip to the operating room. In irradiated tissue, the HBO increased the flap viability, while the V.A.C. prepared the wound bed for muscle coverage. The fasciotomy wounds all had rapid and improved take of the grafts. Many factors come into play when healing a complex wound. The V.A.C. and HBOT appear to compliment each other thereby increasing wound closure options. In wounds that may be thought of as unsalvageable, this combined treatment may offer a possibility for successful wound closure.