By Adam Strohl, MD

Who else dreads trying to “get the seal” on hand wounds using a Wound VAC?
I offer you this pearl…

For those managing complex traumatic wounds to the hands requiring multiple debridements and eventual soft tissue coverage, negative pressure wound therapy (NPWT) such as the Wound VAC is often employed for temporary coverage.  Unfortunately, wound proximity to interdigital webspaces poses risk of “leak” with the device.  Despite attempts with multiple strips of occlusive dressings in the webspaces, air leaks are common with movement of the fingers post-operatively.  We all know the frustration of these leaks that lead to failure of the treatment and ultimately replacing the dressing or abandoning NPWT.

While attending an upper extremity conference during my residency, I learned about the very clever use of a surgical glove to replace the use of occlusive dressing sheets.  The suction tubing attaches directly to the glove by making a hole over the sponge as one would with the transparent, occlusive sheets.  The glove itself essentially gets “sucked into” the webspaces and seals those potential leak spaces.  The fingertips of the gloves can be removed to allow for neurovascular checks, and the proximal cuff is secured with one, simple strip of occlusive dressing material.

This technique absolutely changed my practice and has saved a lot of frustration and phone calls from nurses.  The same concept can be used for wounds of the foot.  It can be adapted to wounds involving external fixators by placing sponge foam over the ends of the fixator pins then covered with the glove (see Gerszberg KS, Tan V. Vacuum-assisted closure with external fixation of the hand. Orthopedics. 2009 Nov;32(11):829).  Mild maceration of the palm can be seen with extended use but has not led to secondary complication or consequence.

I hope this “pearl” is as useful for you as it has been for me!

Adam Strohl, MD
Philadelphia Hand to Shoulder Center
Thomas Jefferson University Hospital
Philadelphia, PA