I was delighted to read the article describing the use of closed suction wound drainage (also called vacuum or negative pressure therapy) by Ms Jones and Ms Harbit in JWOCN, November 2003. The myriad complications their patient presented reminded me of those I encountered on Halloween night 1985 in the Intensive Care Unit at Spartanburg Regional Medical Center, SC. Until their article, I thought my critically ill patient with a dehisced midline wound and a small bowel fistula obscured beneath 13 retention sutures with macerated and denuded skin underneath and beyond the retention sutures required prize-winning ingenuity. The magnitude of Ms Jones's and Harbit's challenges dwarfs mine!! However, on that long and frustrating night in October 1985, after multiple attempts with pouching systems and numerous failed tubing and suction concepts, I designed a closed suction wound drainage system. I believe that I am the first person in the United States to have constructed such a system. The important components were a fenestrated drain, moist gauze protecting the wound bed and positioned on top of the fenestrated drain, and transparent adhesive film dressings sealed securely to effect a vacuum. I was so excited that I began describing my experiences immediately in November and December 1985 from the podium at wound care conferences and in conversations with colleagues. This technique was first described in American literature, I believe, by Orringer JS et al.1 While our first article2 did not appear until June 1989 after languishing in the publisher's pending files, we shared the technique at every speaking opportunity, nationally and internationally.

In her commentary, Ms Anderson says, "there are 2 basic approaches to managing this case." She goes on to describe pouching systems. She continues by saying, "A closed suction system, as described in this case, is often effective if attempts at traditional pouching have failed." I continue to be convinced, because of the unexpected and extraordinary wound healing we saw and described and which has been reported by others over the past 18 years, that closed suction wound drainage would be the first and preferred method of management of complex and recalcitrant wounds. In our paper, we referred to our first 7 patients managed with closed suction wound drainage. In all 7 patients, we were impressed by the rapid epithelialization and wound contraction we saw. There are numerous other benefits: Significantly less nursing care time is required when wound drainage is contained. Patients are much more comfortable. Costs are greatly reduced. Appearance and quantity of output are easily monitored. Skin integrity is preserved. In my opinion, this is not a modality to be reserved for catastrophic wounds in complex circumstances. All wound care specialists should be familiar with this technique and prepared to apply it.

I am delighted to report that Blue Sky Medical, a LaCosta, Calif, company has developed a kit with all the components required to implement vacuum drainage giving us yet another option. With this kit, clinicians no longer need to forage in materials management and cannibalize existing products to assemble a system. It has been too many years since we first described closed suction wound drainage for it to be considered a novel or last-resort modality. Perhaps collecting the items required to assemble the system has been daunting to wound care specialists, who have not been taught to use this procedure. If so, this new kit has removed the last obstacle.

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