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| Dr. Joel Aronowitz |
Dr. Joel Aronowitz: “Okay, we've seen and heard a lot about wound vacs, and I think it's helpful to take a step back and just review what that's all about. So it turns out we have an extra vac sponge here. A wound vac is a solution to an open wound that a very clever plastic surgeon came up with a few years ago, did a lot of work in researching, and now it's really a standard of care for a lot of open wounds. So let's say we have an open wound. The skin can't be closed together, so it's going to need to close from the bottom up. Instead of just packing the wound with gauze and changing that gauze every day, now we have a new solution. So once the wound is clean of necrotic or dead material, there's no infection, then the way the vac works is we put a sponge, and this shape and size may not fit all wounds, so we just take a scissor and cut the shape and size that we need to fill the wound. So this sponge goes into the wound. What's happening is that sponge is in contact with the wound. Stay here because I need you in a minute. That sponge scrunches down under the vacuum, and the vacuum is about between 75 and 125 millimeters of mercury. It's drawing out any fluid from that open wound, and it's assisting the natural contraction of the wound by using the power of that vacuum. And then it's also simplifying the wound care for the patient because it doesn't need to be changed every day or several times a day. There's also, on a cellular level, things going on caused by that negative pressure that stimulates the healing of the wound, probably having to do with physical distortion of the cytoskeleton of the fibrocytes and other cells. Why is that funny?
Jessica Olson, DPM: “Here we are for the wound vac application. Nice thing about wound vacs, you can place them directly on the wound bed. The black foam typically goes over soft tissue, white foam can go over tendon and bone. You can also place a graft underneath there if you wanted to and then protect it with an adaptive layer. So if that's the case, you put down your biologic graft, put your adaptive or non-adherent layer around there, steristrip it, and then put the wound vac right on top. Now a wound vac requires some practice as, if you've ever put one on as you know, making sure you have an appropriate seal is the best part or is sort of the critical part in that. Oh yeah, you have to give your assistant some credit. Yeah, I know, they're good. Here. No, the guy, he put collagen in there.”
Patient: “And put it on, yeah.”
Jessica: “So yeah, the collagen can help. You like it when it's moving up, huh? So this is the prepackaged foam. So essentially what you do is you measure it out and you cut it. One technique you can use is just pushing it onto the wound, and then if it's a heavily draining wound, it will outline itself. We've already pre-cut a piece that will fit this side here. So you measure that out and then you start to tape it down. I can do a little pre-tape or the pre-wipe to make sure that you get a good seal.”
Patient: “Mm-hmm.”
Jessica: “And then I'll have you start opening these. I'll take a dry gauze. Good. Some little pearls on how to put this on.
Patient: “You've got business cards, right?”
Jessica: “Yeah, I think so. Dr. Olson at Tower Wound Care.”
Patient: “I need to take your business card to Dr. P's office.”
Jessica: “So this layer here, you sort of want to keep that pressure right down in the center. Sometimes it helps to have an extra pair of hands. So if you have someone around to help you put it on, it's always helpful. And you pull off number two and then pull this.”
Patient: “What happened out of all areas of medicine you ended up in wound?”
Jessica: “Sports. I played college basketball.”
Patient: “You did?”
Jessica: “And I had some bad ankle injuries myself. Well, you did. I always wanted to go into medicine and sports in general. And podiatry was very much...”
Patient: “You do sports medicine again?”
Jessica: “I do. I treated some college athletes out in Boston where I moved from last year. And then all sorts of young kids like your AYSO soccer leagues and your high school basketball, hockey, all sorts of sports. And then you can see that you have a good seal there. You can always cut down different levels of tape if you need it. And then you can either use a scissor or a blade to cut the little central hole. Hey! You have a jokester. So that allows the center part of the wound there. Now for the application for this part, the pearl is you always want the tube going up the leg. So you don't want it coming down here or going around. And you want to keep it off of any bony protuberance to prevent any sort of wound. So you could just put it right there. Peel off. Sort of foolproof. It tells you which one to pull off when. There's number two. And then number three. And then I will take a couple of... Typically at this point, I like to make sure that the seal is working. So I put on a couple extra layers of tape. And then we fire it up. Make sure that we have no leaks. And then...if we have a leak, usually we can get it taken care of with an extra piece of tape. Like this. Make sure you have a good seal so you don't get a call at Friday night at midnight saying my wound vac is down for the weekend. We've all been there. All right. And then I'll have you power up the wound vac for me. Typically pressure settings at negative 125. Some differences there, but generally it's maybe 125. Continuous. And you can see that it's functioning appropriately there. And then proper way to offload a wound vac or put a dressing on around it. He doesn't have a ton of edema, but we want to put a nice little compression dressing. We made this into a drain sponge. I'll take an ABD pad. I'm going to pad this guy around here. And you don't want the cord resting right on the skin too, because that can cause a pressure injury as well. Especially if there's any vascular compromise or any sort of history of systemic wound healing issues. And go ahead and make this into a drain sponge. Essentially perfect. A little extra cushion makes it more comfortable for the patient as well. And then just do a curlex, coban, and voila.”
Patient: “Thank you.”
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