[V.A.C.-therapy: a treatment option for wound healing complications after achilles tendon reconstruction].

INTRODUCTION: The postoperative course after Achilles tendon reconstruction is associated with a high incidence rate of infections and wound healing complications, which can lead to protracted healing process and, hence, limit the clinical outcome. PATIENT-METHODS: A 66-year-old male was referred to our clinic with an Achilles tendon rupture. MRI confirmed the diagnosis, an augmented tenoplasty was performed for tendon reconstruction. 11 weeks after surgery the patient presented himself again with an open wound and local infection signs. RESULTS: The surgical treatment included debridement and jet lavage. The V.A.C.-device with the white polyvinyl sponge at an initial pressure of 200 mm Hg was used. A pathogen organism could not be identified. For infection eradication a broad spectrum systemic antibiosis (cefuroxime and gentamicin) was applied. On 3., 6. and 14. day the dressings were changed and the wound was revised under progredient closure. At beginning formation of granulation tissue the pressure was reduced to 150-100 mm Hg. At decreasing blood inflammation parameters and amelioration of the local wound condition the patient could check out after 3 weeks hospitalization. After further successful ambulant management by means of the V.A.C.-therapy a meshgraft transplantation was performed (enlargement factor 1.5; layer thickness 0.3 mm). The V.A.C.-device was applied again at a pressure of 150 mm Hg with a single dressing change after 5 days. At a follow-up of 31 months no further complications occurred. DISCUSSION: The V.A.C.-therapy seems to be a valuable tool in the treatment of wounds with a critical local vascularity. After successful wound preconditioning the healing process of skin grafts transplants can be also optimised by means of the V.A.C.-device.