V.A.C. therapy represents an essential tool for treatment of complex injuries of the upper extremity with extended soft tissue defects. Decreased frequency of dressing changes as well as reduced tissue oedema considerably improved patient's comfort. Posttraumatic compartment syndrome or skin necrosis, which are often associated with macro amputations of the upper extremity, are efficiently treated with V.A.C., and secondary sutures may be performed despite initial skin defects.

Marjolin ulcers are scar carcinomas most often found in old instable burn scars, the majority histopathologically characterized as squamous cell carcinomas. Surgical therapy includes radical excision and subsequent defect closure. We report about a 69 year old patient suffering from two scar carcinomas on the right cheek and right chest and abdomen due to an extensive infant burn injury. During a 2 stage procedure, both ulcers were initially excised and resulting soft tissue defects were closed temporarily by applying V.A.C. therapy. During a second procedure defect closure on the right cheek was achieved by using a free radial forearm flap following neck dissection. Additionally, the extensive defect including chest and abdominal wall as well as the flap donor site on the left forearm were covered with split thickness skin grafts and subsequently secured by applying V.A.C. therapy for 5 days. 13 days later, the patient was discharged from our clinic. All skin grafted areas as well as the free flap were stably healed. Our report demonstrates that the application of vacuum therapy is not only useful during temporary closure of large wound sites but also secures healing of large and critical areas grafted with split thickness skin grafts in tumour patients.