The "Glove-VAC" Technique: A Two-Patient Case Series of Custom Sealing Systems for Complex Hand Injuries

Abstract

Background: Negative pressure wound therapy (NPWT) is widely used to support wound-bed preparation in complex soft-tissue injuries. Its application to hand wounds can be challenging because the contours of the digits and interdigital spaces may compromise maintenance of an airtight seal. In resource-limited settings, the cost and availability of commercial NPWT systems may also restrict use. This case series describes a modified, low-cost sealing method using a sterile surgical glove for complex hand injuries. Technique and Cases: A sterile latex or nitrile glove was used as the occlusive interface after wound debridement and placement of gauze or foam over the defect. A French size 16 suction tube, with additional distal fenestrations, was positioned within the dressing and brought out proximally through the glove cuff. The cuff and tube exit site were sealed at the distal forearm using adhesive drapes, and the system was connected to continuous institutional wall suction. The technique was applied in two patients with complex right-hand wounds. The first patient had a partial degloving injury with flap necrosis after primary closure under tension. After debridement, the modified system was used for two dressing cycles, followed by split-thickness skin grafting. The second patient was a 30-year-old male with a high-voltage electrical burn involving the right hand, with exposure of deep structures. The modified system was also used for two dressing cycles to prepare the wound bed for planned pedicled inguinal flap coverage. Results: In both cases, the dressing maintained wound coverage and supported the formation of healthy granulation tissue. The first case proceeded to skin grafting, while the second case achieved wound-bed stabilisation before planned flap reconstruction. Conclusion: The modified Glove-VAC technique may provide a simple and accessible option for temporary negative pressure wound management in selected complex hand injuries, particularly where commercial systems are limited. This is an early technical experience rather than evidence of superiority over commercial NPWT systems.