Title: Salvage the Split Thickness Skin Graft by using the combination of V.A.C Therapy and SelectSilver Wound Dressing.

Clinical Problem: A 57yo female w/hx HTN, IDDM, Osteomyelitis @ Rt Foot w/Transmetarsal Amputation.  Failed STSG after Transmetarsal Amputation.

Description of Past Management:

Patient was presented with transmetatarsal amputation of rt foot with placement of V.A.C therapy. 5 weeks post amputation, STSG applied to amputation site and orders were given for Dakins solution 3 times a day. After 4 weeks post STSG, MD documents that skin graft is gone and wound has resumed previous appearance with copious amounts of serous drainage. Suggested that wound care of daily application of foam and roll gauze.

Current Clinical Approach:

Patient was concerned and frustrated by excessive drainage and odor which required 2-3 dressing changes per day and excessive supplies.  Suggestion was made to use V.A.C Therapy and SelectSilver antimicrobial wound dressing to manage the excess drainage and bioburden in the wound bed to promote healing. Wound has been opened for greater than 4 months. SelectSilver dressing was fenestrated to allow the fluid to pass through and pressure was increased to 150 mmHg to accommodate contact layer.

Patient Outcomes:

After 12 days of changing therapy to V.A.C Therapy and SelectSilver, MD confirmed epithelialization in center of wound bed.  After eights weeks of NPWT and SelectSilver, epithelialization has more than doubled in size with significant decrease in drainage and odor.

Conclusions:

Amputation site was facilitated to closure by using Negative Pressure Wound Therapy and antimicrobial wound dressing. This combination therapy prevented additional surgery for second graft and improved patient's quality of life. Wound has closed more than 70% in last eight weeks.