A 54-year-old man with the following personal history: ex-alcoholic, ex-smoker, chronic obstructive pulmonary disease (COPD) classified as moderate-severe mixed respiratory disability, liver disease, polyarthrosis, polymyalgia rheumatica and Barret's oesophagus. Due to chronic corticosteroid treatment, in May 2010 he suffered an osteoporotic vertebral crushing for which he underwent surgery consisting of vertebral fusion D2-D7 and vertebroplasty D4-D5. One month later, he was transferred to our hospital with a diagnosis of D4 ASIA C transverse spinal cord injury syndrome for evaluation and rehabilitation treatment; the latter was impossible from the outset due to the instability of the vertebral injury. In addition, it was necessary to perform daily local dressings and every 2-3 days regular dressings in the operating theatre due to the presence of an open, infected and sphacelated wound in the upper dorsal vertebral region. In this way, an attempt was made to maintain the osteosynthesis material and prevent the clinical evolution of his spinal injury. Finally, given the impossibility of reducing the bacterial load of the wound and proceeding to close it, we decided to remove all the osteosynthesis material in October. We prescribed cures with local antiseptics until a suitable bed was achieved in order to perform, in January 2011, a trapezius flap with a skin paddle to cover the existing defect. In the immediate postoperative period following this operation, untimely postural manoeuvres were performed, which iatrogenically caused venous congestion of the described flap. One month later, we proceeded to debride the affected tissues and placed 2 portable VAC® systems for one month: one to manage the exudate generated in the area of the muscle detachment and the other in the cranial and caudal part of the skin flap. We chose the black foam dressing modality (granufoam: polyurethane 400-600 micrometre pore size) for the dressing because it was a relatively small residual wound (4 x 5 cm), with few signs of infection, and because of the need to improve local blood flow to limit tissue loss and thus promote the generation of granulation tissue. Therapy was instituted continuously at -125mmHg for the first 48 hours and then lowered to -75mmHg until the end of treatment.

In March 2011 we covered the 3 previously described areas with autografts, already granulated, and fixed them with a state-of-the-art portable VAC® system (VIA®) for a further week at -75 mmHg, and the patient was then transferred to the Rehabilitation Service to continue with his gait recovery programme.