Modifizierte 'Handschuhtechnik' zur Vakuumtherapie an der Hand

INTRODUCTION During the last 10 years sub-atmospheric pressure dressings (Topical Negative Pressure Therapy = TNP) has become a well accepted standard therapeutic modality in the management of acute and chronic wounds. However, in the hand and the fingers TNP treatment is not as an established method as elsewhere in the body. This is mostly due to difficulties in the technique of sealing wounds near the interdigital folds, especially when the interdigital folds are affected themselves. MATERIALS AND METHODS Over a period of 36 months we treated 9 extensive open wounds of the hand with the TNP dressing procedure. To optimize the effective sealing procedure several methods of closure were applied: sterile vinyl gloves, split V.A.C. gel-straps and the "Sandwich"-principle. RESULTS In all cases we were able to achieve a tight vacuum sealing with the use of our vinyl or latex free surgical glove as an aid to cover the interdigital spaces. There was a rapid and complete remission of the symptoms in terms of edema, redness, tenderness and range of motion. The indication spectrum encompassed infection control, temporary coverage of exposed bone or tendons, intermittent irrigation with local antiseptics as well as wound preconditioning before skin grafting or flap coverage. For the definite closure or coverage a second operation was necessary in all cases. CONCLUSIONS The TNP-dressing can be securely achieved even in wounds encompassing the interdigital folds or adjacent to the in digital spaces with a modified surgical gloving technique to aid the standard sealing foil. It is a suitable principle for the management of severe hand infections with a reduction of clinical symptoms, reduction of the frequency of dressing changes compared to open approaches and a significant amelioration in the quality of life both for patients and health care personnel.