With a perineum wound that was refusing to heal, was frequently infected and had joined up to a pilonidal surgery, a different solution was required in the form of a vacuum-assisted closure aka a VAC aka negative-pressure wound therapy.
The ‘radical’ surgery involved completely reopening the Ken Butt and the resulting wound was long, wide and large. A bonus meant that the pilonidal sinus had been scooped out in the process. The wound had been expertly packed by a surgical care practitioner who is a stickler for ensuring that it’s done correctly. The dressing stayed on for the entirety of the weekend and by the fourth day it had become rather stinky! VAC fitting day couldn’t have come sooner.
The VAC was being fitted by the Surgical Care Practitioner who had packed my wound after the surgery. She arrived with a range of kit and then scurried off to another part of the hospital to source the rest. 30 minutes later she returned with what looked like a toolbox and was ready to start the ‘installation’.
She was joined by a stoma nurse who would be assisting and a curious ward nurse. Ideally a VAC dressing in the perineum would be added in a lithotomy position (that’s a new word to me) where your legs would be raised but that’s hard to achieve on a hospital bed so it was a simple ‘lay-on-your-side-and-stuff-a-pillow-between-your-legs’ position.
The procedure started with stoma nurse shaving my perineum and man bits (poor woman!) and ensuring that the area had been washed and thoroughly dried. Next foam was to be added to (I think) help keep the cavity open and allow the exudate drain. This wasn’t liquid foam but an actual piece of foam that would be cut to size. The wound is fairly sizeable but I was still wondering how it was going to fit in. With a bit of pressure, and pain, a couple of pieces were packed into the wound.
Strips of adhesive tape were then cut and applied over the top of the wound until completely sealed. Once sealed a hole was cut and the tube which would suck out the exudate was affixed. The tube is then attached to the machine and it starts to do its job. The procedure took around 20 minutes to complete and apart from some slight pain when packing the foam was applied.
Afterwards, the area was rather sore which was probably a combination of the packing being left in for so long, being removed and then pressure being applied by the VAC.
How It Looks When Installed
What Does a VAC Sound Like?
The machine is constantly sucking out exudate and maintaining a vacuum so it’s not silent and when it’s not having a work hard it’s a constant ‘clicking’ noise. If the VAC has too work harder due to, for example, the position of your body the noise increases. Here’s an example of the different levels of noise.
Soon after being discharged, and not even leaving the hospital grounds, the VAC starting emitting an alarm. The alarm was announcing that the container that collects fluids was full when obviously it wasn’t. After returning back to the hospital and ‘turning it off and on’ it was back in action. It was possibly due to pressure on the tube.
Just a few hours after returning home, the same alarm triggered and luckily it was around 5pm so I could make a call to the surgical care practitioner who fitted the VAC. An hour later she was at my home trying her best to add additional tape to try and stop air escaping from the perineum. It’s a difficult area to apply a VAC so her parting shot was to stuff a flannel down there to make sure no more air leaks out!
How Are They Changed?
The dressing is designed to stay on for a number of days so that it gets a good chance at doing its job. The VAC will fill up with the drained exudate and after around 3 days will be replaced along with the entirety of the dressing. I’ve also been given gauze which can be used instead of foam. The dressing will need to be replaced by a district nurse and the VAC is likely to stay on for 2-3 weeks. At that point it’s hoped that the wound will have healed well enough for the VAC usage to stop and then I would head back to the GP for standard dressings by the practice nurse.
Will I Still Be Able To Do Things?
Hopefully! The early days with one need to be taken easy but as time progresses and I get used to it I’m hoping that I’ll become more mobile and get around and about As a frequent cinema goer I’m going to have make sure I don’t choose a quiet film otherwise I’ll have to site in the corner so as to not disturb anyone!