From the Guidelines
Yes, a wound vac can be placed on top of exposed muscle, but it is crucial to use a non-adherent interface layer to protect the muscle and prevent complications. When applying a wound vac to exposed muscle, a non-adherent contact layer should first be placed directly on the muscle tissue to protect it, followed by the appropriate foam dressing and then the adhesive drape and suction tubing 1. The pressure settings typically range from -75 to -125 mmHg, with lower pressures often used initially for exposed muscle to minimize discomfort.
Key Considerations
- The wound vac helps by removing excess fluid, reducing edema, increasing blood flow to the area, promoting granulation tissue formation, and reducing bacterial colonization.
- The dressing is typically changed every 48-72 hours, depending on the wound characteristics and institutional protocols.
- It's essential to monitor for signs of infection or deterioration of the wound.
- Wound vacs are contraindicated if there's active bleeding, malignancy in the wound bed, or untreated osteomyelitis, so these conditions should be ruled out before application 1.
Application and Monitoring
- The use of a wound vacuum-assisted closure device enhances healing by negative pressure and simplifies wound care by nursing staff, but it should not be applied if purulence is present in the wound 1.
- The choice of a rotational or transpositional muscle flap should be made in consultation with vascular and plastic surgeons, and some surgeons have recommended wound coverage with a vacuum-assisted closure device, either alone or as a possible bridge to muscle flap 1.
From the Research
Wound Vac Placement on Exposed Muscle
- The placement of a wound vac on top of exposed muscle is a topic of interest in wound care, with several studies exploring its effectiveness and safety 2, 3, 4, 5.
- A study published in the Journal of Vascular Surgery in 2005 found that vacuum-assisted closure (VAC) therapy can be used to preserve infected and exposed vascular grafts without muscle flap coverage 2.
- Another study published in Der Unfallchirurg in 2001 discussed the use of vacuum-assisted wound closure (VAC) for various wound applications, including traumatic wounds and infections, but did not specifically address exposed muscle 3.
- The International Wound Journal published a study in 2004 on topical negative pressure therapy, which included indications for clinical use such as traumatic wounds and wound bed preparation, but did not provide specific guidance on exposed muscle 4.
- A study published in Plastic and Reconstructive Surgery in 2001 used vacuum-assisted closure therapy to treat lower-extremity wounds with exposed bone, tendon, or orthopedic hardware, and found that it greatly reduced tissue edema and promoted granulation tissue formation 5.
- While these studies do not directly address the placement of a wound vac on exposed muscle, they suggest that vacuum-assisted closure therapy can be effective in promoting wound healing and managing complex wounds 2, 3, 4, 5.