Practice Lesson of the Week

Chronic wound sepsis due to retained vacuum assisted closure foam

BMJ 2009; 338 doi: (Published 24 June 2009) Cite this as: BMJ 2009;338:b2269
  1. Daniel Beral, specialist registrar1,
  2. Robert Adair, clinical research fellow1,
  3. Adam Peckham-Cooper, foundation year 2 1,
  4. Damian Tolan, consultant radiologist2,
  5. Ian Botterill, consultant colorectal surgeon1
  1. 1The John Goligher Colorectal Unit, Leeds General Infirmary, Leeds, UK
  2. 2Department of Clinical Radiology, Leeds General Infirmary
  1. Correspondence to: I Botterill ian.botterill{at}
  • Accepted 12 September 2008

Count radiolucent foam pieces used in outpatient vacuum assisted wound closure to prevent chronic sepsis

Vacuum assisted closure therapy is widely used in the management of complex wounds. Negative pressure in a closed environment promotes healing, with a reduction of wound colonisation and an acceleration of ingrowth of the granulation tissue. Vacuum therapy was originally devised for use in secondary care, but technological advancements mean it is now used in primary care too. Although the retention of surgical instruments and swabs inside body cavities after surgery is well recognised, the retention of foam dressings used in vacuum therapy has not been widely reported. Outside of the ordered theatre environment, however, dressing counts may be overlooked, and with such foam this can have serious consequences because it is radiolucent.

We report a case where foam dressings were retained in a surgical wound leading to chronic wound sepsis and further surgery.

Case report

A 67 year old overweight woman underwent a posterior pelvic clearance (anterior resection of rectum, loop ileostomy, total abdominal hysterectomy, bilateral salpingo-oophorectomy, omentectomy, and lymph node sampling) for a left ovarian mass involving the rectosigmoid junction. Histology showed a stage IIb G1 endometrioid ovarian adenocarcinoma.

Her recovery was complicated by a superficial wound dehiscence, which was treated with vacuum therapy. Two types of foam were used: GranuFoam—standard black polyurethane foam dressing, and WhiteFoam—white polyvinyl alcohol foam with high tensile strength intended for wounds with undermined edges (Vacuum Assisted Closure, KCI, San Antonio, Texas, USA).

The dressings were changed by the hospital’s tissue viability nurses five times over a 15 …

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