Hi Michelle, 

Other colleagues might have other suggestions, sharing some thoughts here. Regarding recommendations for packing options, Dr Charash posted great insights in this curbside consult. 

As for having the surgeon make a larger incision to be able to place a wound vac - one thought to consider is that the use of NPWT in infected wounds requires careful clinical judgment and should be accompanied by appropriate antibiotic therapy and close monitoring for signs of infection. Also, it would be important to check if no contraindications are present (e.g. untreated osteomyelitis, unexplored fistulas, or exposed blood vessels). So, having the surgeon just make a larger incision, without proper blunt dissection of loculations, removal of pus/debris, or assessment of contraindications, would not be enough to provide adequate preparation prior to placement of NPWT. Alternatively, for patients in an inpatient setting where this resource is accessible and the patient does not have any contraindications, considering NPWT with the application of a cleansing solution (e.g., VeraFlo) could be an option. See case study