Vacuum-assisted wound closure or negative pressure wound therapy (NPWT) is increasingly being used to promote wound healing in different situations with a downgrading of the reconstructive ladder (Table 1).1-5 In the previous 2 years of writing this article, the authors treated 27 patients who had trauma to their limbs with Kirschner wires and NPWT for soft tissue lost. The average time to apply therapy was 23 minutes because of the difficultly in sealing the dressing around the Kirschner wires (Figure 1). The authors' method is an easy, fast, and inexpensive way to apply NPWT in that situation.

Table 1. DOWNGRADING OF THE RECONSTRUCTIVE LADDER WITH NPWT

Figure 1. PREVIOUS METHOD OF APPLYING KIRSCHNER WIRES

From June 2006 to December 2006, the lead author was called to apply NPWT to 15 patients with trauma of the limbs. To decrease the time spent to seal the dressing around Kirschner wire with many films of polyurethane, the author used a common silicon gel around it instead. If the Kirschner wire crosses the polyurethane foam, the silicon gel is applied between the film, the foam, and the metal; if the wire crosses the uninjured skin, the author uses an antimicrobial dressing with chlorhexidine gluconate (Biopatch; Johnson & Johnson, New Brunswick, New Jersey) over the skin to reduce the risk of cutaneous-subcutaneous infection, and the silicon gel is applied among the film, the antimicrobial dressing, and the metal (Figures 2 and 3).

Figure 2. USING SILICONE GEL AROUND THE KIRSCHNER WIRES

Figure 3. SILICON GEL APPLICATION

The average time the application took the author was 11 minutes. In addition, the lead author was never called upon in the following days to modify the dressing, which was in contrast to the previous method that required him to correct the dressing in 8 patients.

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