PURPOSE: Since its introduction, the Vacuum Assisted Closure device (V.A.C.) has been used for a multitude of wound problems. It has been used primarily for wound care and closure. It has also been used for marginally ischemic wounds in order to promote a demarcation between viable and non-viable tissue. This is a case report of salvage of a free flap.

CASE REPORT: The case presented here involves a 28 year-old male patient who had a Stage IIIb tibia/fibula fracture with extensive degloving of the pre-tibial region. A rectus abdominus free tissue transfer was performed with vein interposition grafts for the arterial and venous anastomoses. The patient suffered repeated arterial anastomotic leaks and repairs over an eight day period. The anastomosis leaked at the vein interposition graft to the superficial femoral artery (SFA). The repairs performed included a vein patch graft to the SFA, segmental resection of the SFA with reversed interposition vein graft and finally an extra-anatomic bypass vein graft. Each of the first repairs leaked and the extra-anatomic bypass thrombosed. The SFA was ligated as was the arterial inflow to the free flap leaving the flap with just the wound bed as its only blood inflow from soft tissue inosculation. The outflow via the interposition vein graft to the superficial femoral vein was in tact. The flap was viable during all the revascularization procedures. After the ligation of the inflow, there was a change in the appearance of the flap consistent with ischemia. The wound V.A.C. was applied and there was pronounced recovery of the flap. The V.A.C. was changed every other day for ten days and then a split thickness skin graft was applied.

OUTCOME: The patient had the external fixator removed 10 months later after there was satisfactory healing of the fracture. No bone grafting was required and the patient did not require any revision of the flap and had symmetric appearance.

CONCLUSION: The vacuum assisted closure device has been used on wounds to help with closure and prepare wound beds. It has also been used to help ischemic tissue secondary to trauma or burns. In this case, the algorithm for care for the patient followed accepted treatment for the severe complication of infected anastomoses. The final treatment, though, incorporated the V.A.C. and saved the patient from a number of more complicated limb salvage measures and possibly amputation.