control bleeding prior to application

clean and dry the skin margins thoroughly

apply skin adherent (Mastisol, Benzoin Tincture, or other skin adherent) to wide margin of skin

cut VAC sponge to fit completely within wound margins

cut transparent drape material to shape of wound with overlap of 4-5 cm on all edges

use as little transparent drape as possible in order to prevent creases and air leaks

Pressure Settings:
a.  125mmHg Continuous for most wounds
b.  75mmHg Continuous for wounds that are post skin or bioengineered tissue grafting (first 5-7 days)
c.  125mmHg Intermittent when tolerated. Usually we switch patients from continuous to intermittent therapy after 48 hours. Note that sensate patients may have a difficulty with intermittent therapy initially due to increased pain. Granulation tissue formation is significantly faster with intermittent pressure setting.

if you have difficulty with maceration to the wound edges, use a stronger skin adherent or increase the pressure to 150mmHg. The most common reasons for maceration are: poor seal to wound margin, air leak, sponge overlap to margin.

if you must include digits in the dressing, be sure to place small piece of VAC sponge between digits to decrease maceration

on occasion I will have a patient take a break from the VAC for 1-2 days to get maceration and other concerns under control before re-application.