With a perineal wound that wasn’t healing after 8 months, it was time to bring out the big guns and try a VAC dressing. This is something that had been mentioned many times during my many dressing changes and whilst I had an idea of how they operated, I didn’t know what it would be like to have one. The aim of this blog post is to explain more about them and how I’ve coped with having one.
Note: A VAC dressing can be used for a variety of wounds and the machine can be operated in different ways but this blog post is specifically about my use of one for a perineal wound.
Negative-Pressure Wound Therapy
Negative-pressure wound therapy (NPWT) aka a vacuum dressing or VAC dressing is a technique used to remove excess exudation and promote healing. It achieves this by maintaining a tight vacuum around the wound to draw off the exudate and to increase blood flow around the surface of the wound.
What is the Purpose of the Machine?
The machine is generally used for more serious wounds, large wounds and wound that are taking a long time to heal. By maintaining a clean vacuum, the aim is to rapidly heal the wound to a point where the machine can be removed and more traditional wound management can be resumed. The period of time that you can wear a VAC dressing does appear to vary, depending on wound size and how quickly it heals, but at you would expect to wear one for at least a few weeks.
How Does the Machine Work?
The machine provides constant therapy by maintaining a vacuum. The machine is battery powered which you keeper charged via a mains adapter. The pressure is set, e.g. to 120mmHg (millimetres mercury) and the machine will always try to keep it at that pressure. If there is a slight leak, and chances are there will be with a perineal wound, the machine works a bit hard to maintain the pressure and when resolved (perhaps by keeping your legs shut!) it returns to idling.
The machine isn’t quiet, but at the same time it isn’t loud. It’s continually chugging away like a little outboard motor or generator and in a public environment you wouldn’t hear it but watching a quiet film in the cinema may require you to sit away from people. However, I’ve already watched a few films without issues.
The machine has a canister attached to its base and it sucks out the exudate from your wound it stores it here until changing. The canister does contain a packet of special powder which will bind to the exudate so there’s not fluid stored.
How is the VAC Dressing Applied?
The first step in applying the dressing involves packing the wound cavity with a material that will keep it open and allow the exudate to drain out. This material can either be foam or gauze that is cut to the size of the wound.
The area is then covered in an adhesive drape/film that ends up looking like your butt has been wrapped in cling film. This will help maintain the vacuum although it’s quite a challenge maintaining the seal at the top and bottom or your butt.
Once the area has been covered in the drape, a small incision is made to allow the soft port (tube) to be attached. This will then be connected up to the machine. Then the moment of truth comes when switching on the machine and checking that it can maintain a tight seal. I’ve only had a few changes so far and each one has successfully maintained a seal.
Wearing the Machine
My particular machine is a Smith + Nephew Renasys Touch which is a portable machine that can easily be carried around the home and outside. It comes with a carrying case and strap so looks like you’re carrying a small bag – with a tube extending from it to your butt!
I haven’t found the VAC dressing itself to be too difficult to wear and any discomfort that I’ve experienced has been due to the wound itself. The material of the soft port and tube, and how it extends up along your butt crack (at least in my case), means that it’s doesn’t get in the way when sitting down.
Sleeping with it hasn’t proved to be difficult and the tube is long enough that I can keep the machine on the floor plugged into the mains and have enough to allow me to sleep in a number of positions. The only issue I’ve experienced is that in some positions you may inadvertently open up the seal and cause the machine to alarm. I quickly got to understand the machine and understand how to deal with the alarms – turning it off and on usually does the trick!
The one unfortunate side of wearing a VAC dressing means that you have to avoid showering whilst wearing it and this means going around 3 days without having one. If your district nurses are good they will call you in advance to let you know they are on their way so you can have a shower before a change.
Wearing it Outside
In it’s carrying case, the machine is discrete and just looks like you’re carrying a bag but there is the long tube (maybe 4 foot in length). There is also the soft port which the tube is connected to that extends to the wound. This is a compression resistant channel that is covered in a white plastic that is very noticeable. The carrying case does come with a small pouch where you can store some of the tubing but you won’t be able to store it all so there will always be some visible.
I didn’t want the machine to restrict me from going out in public so I was happy to wear it from day one and whilst I store the excess tubing in the case’s pouch, I’m not concerned about the white soft port element being on display. If you were really concerned, and it’s completely understandable to be, you could conceal everything by wearing certain clothing.
I’m sure lots of people have wondered why there’s a tube coming out from my butt but so far nobody has asked about it.
Does a VAC Dressing Work?
Time will tell as I’ve only had mine on for a week (when this was posted) so I will need to update the post when the dressing is removed.