LETTER TO THE EDITOR
The oval sponge: a simplified method for scrotal skin graft
fixation using VAC device
Shabeer Ahmad Wani
Sari M. Rabah
Mohammed Y. Mirza
Received: 10 July 2014 /Accepted: 16 August 2014 /Published online: 12 September 2014
Springer-Verlag Berlin Heidelberg 2014
The vacuum-assisted closure (VAC, Kinetic Concepts, Inc.,
San Antonio, TX, USA) is a widely used device in wound
management. It has been postulated that the VAC machine
provides a favorable environment for skin graft uptake due to
its ability to clear wound exudate, enhance the production of
granulation tissue, and to reduce soft tissue oedema . More-
over, the physical flexibility of this device has proven to be
very beneficial in optimizing skin graft uptake at difficult
anatomical sites . Therefore, the VAC machine has been
commonly applied as an initial wound dressing .
Fournier’s gangrene is a rapidly progressive subcutaneous
necrotizing fasciitis of the perineum, genitalia and abdominal
wall. This condition often leads to variable degrees of soft
tissue loss and necrosis, which would require a series multiple
debridement and ultimately reconstruction with a skin grafts
or local flaps.
Due to the anatomical location of the soft tissue defects in
Fournier’s gangrene, the reconstruction with a skin graft poses
a great deal of difficulty.
The objectives for using a VAC device would include, but
not limited to: easy applicability, complete skin graft uptake
and acceptable aesthetic result. Huettinger et al. described their
method of covering urogenital defect areas following necrotiz-
ing fasciitis; through utilizing a basket-shaped VAC in fixation
of split thickness skin graft over the affected area . The
authors have managed to effectively achieve outstanding re-
sults through modifying the shape of the VAC intra-operatively
into a basket shape, which would form a three-dimensional
cover to the scrotum. Other emerging VAC fixation techniques,
such as the “sandwich technique”, developed by Djedovic et al.
have also yielded favorable results .
At our institution, we have established a method for
reconstructing post necrotizing fasciitis perineal defects with-
out the use of a basket-shaped VAC. As a tertiary care center,
we receive a great number of cases from all over the kingdom.
Given the simplicity of the technique and the favorable out-
come, we feel that it is worth sharing with the readers.
A 50-year-old male, with a known case of diabetes mellitus
and hypertension, presented to our Emergency Department
3 days post hemorrhoidectomy at a local private hospital.
Imaging findings were suggestive of Fournier’s gangrene.
The patient was septic and an emergency debridement and
loop colostomy was performed (Fig. 1). Ten days later, we
took the patient to the operating room for reconstruction. A
partial thickness skin graft was harvested from the patient’s
thigh, meshed and applied. For graft fixation, we used an oval-
shaped VAC sponge applied over Vaseline gauze. The sponge
was cut from its original size into a simple oval shape which
covers the size of the soft tissue defect. The sponge was then
covered with non-adherent dressing films, which was then
adjusted to fit the wound contour (Fig. 2). Wound dressings
were changed on the fifth post-operative day, and the graft
uptake was 100 %. Results were evident 2 weeks post recon-
struction (Fig. 3).
We agree with Huettinger et al.  that the VAC basket
provides an ideal setting for graft uptake. However, the
applicability of such technique may require a longer intra-
operative time as well as discrepancy in estimating the
basket size. From our experience, we believe that our meth-
od provides an easier device applicability as well as compa-
rable cosmesis and functionality with a complete graft
S. AlFadil (*)
S. A. Wani
S. M. Rabah
M. Y. Mirza
Department of Plastic and Reconstructive Surgery, King Fahd
Medical City, Riyadh 11525, Saudi Arabia
Eur J Plast Surg (2014) 37:697–698