The VAC-Basket for Easy Fixation of Scrotal Skin Grafts

667 The vacuum assisted closure (VAC, Kinetic Concepts, Inc., San Antonio, TX, USA) device has revolutionized wound management in recent years due to its ability of exudate clearance, tissue granulation induction and edema reduction [1]. It also has been shown very beneficial in aiding skin graft take in difficult anatomical regions [2]. Fournier′s gangrene is characterized by perineal tissue necrosis caused by bacterial infection. Therapy usually consists of wide debridement together with appropriate antibiotic drug administration to reduce bacterial burden and control infection. After the initial debridement, the reconstructive surgeon faces large raw surface areas in the perineogenital region that have to be covered. This typically can be achieved by skin grafts or local flaps. Due to the three-dimensional character of this region, fixation of the skin graft may be difficult and hinders therefore optimal graft take. In such difficult cases, the VAC device has been utilized as the optimal initial wound dressing [3,4]. Here we want to present our modification for easy fixation and application of a skin graft in scrotal reconstruction after Fournier′s gangrene. A 54-year-old patient was admitted to our Urology department for treatment of a massive soft tissue infection in the perineogenital region. After initial debridement and antibiotic therapy, the patient presented to our department with a global skin defect over the scrotum that was well granulated. The decision was made in favor of skin graft reconstruction. To enhance graft fixation, we constructed our “VAC-basket” out of a regular commercially available VAC-Granu Foam medium dressing kit (Figs. 1, 2). The unmeshed skin graft was harvested from the right lateral thigh region and was initially fixed with multiple interrupted 4-0 Polysorb (Covidien, Mansfield, MA, USA) sutures. Then, the wound edges were secured with doublesided adhesive hydrogel strips (VAC gel). Now, the “VAC-basket” LETTER