Negative Pressure Therapy for Complex Wounds in Patients with Sickle-Cell Disease: A Case Study
|
|
- Barbara White
- 5 years ago
- Views:
Transcription
1 Negative Pressure Therapy for Complex Wounds in Patients with Sickle-Cell Disease: A Case Study Andre Oliveira Paggiaro, MD; Viviane Fernandes de Carvalho, PhD, ETN; Guilherme Henrique Hencklain Fonseca, MD; Allison Doi, MD; and Marcus Castro Ferreira, MD Abstract Sickle-cell disease is the most prevalent genetic disease in the Brazilian population. Lower limb ulcers are the most frequent cutaneous complications, affecting 8% to 10% of the patients. These ulcers are usually deep and may take many years to heal. Evidence about the effectiveness of systemic or topical treatment of these wounds is limited, apart from stabilization of the anemia. A 28-year old woman with sickle-cell disease was admitted for treatment of three deep chronic lower leg ulcers. All wounds had tendon exposure and contained firmly adherent fibrin slough. Following surgical debridement and before grafting, the wounds were managed with three different dressings: a rayon and normal saline solution dressing, a calcium alginate dressing covered with gauze, and negative pressure therapy. All three wounds healed successfully and their grafts showed complete integration; only the rayon-dressed wound required a second debridement. The alginate and rayon-dressed wounds recurred after 9 months and required additional skin grafts. Helpful research on managing ulcers in patients with sickle-cell disease is minimal, but the results of this case study suggest that topical treatment modalities may affect outcomes. Research to explore the safety and effectiveness of NPT in patients with sickle-cell wounds is warranted. Key Words: sickle-cell anemia, lower leg ulcer, case study, wound healing, negative pressure wound therapy Index: Ostomy Wound Management 2010;56(8):xx xx Potential Conflicts of Interest: none disclosed Sickle-cell disease is the most prevalent genetic disease in the Brazilian population. 1 Lower limb (LL) ulcers are the most frequent cutaneous complications, affecting 8% to 10% of the patients. Often seen in the malleoli, these ulcers are usually deep wounds with elevated borders and hyperpigmentation and may contain large amounts of necrotic tissue. Biopsy findings are nonspecific, showing sickle-cell erythrocytes inside the blood vessels of the dermis. 2 The mean time to complete healing of these ulcers has been reported to be more than 3 years, which is three to 16 times longer than for wounds of other causes. 3 In addition, some case studies 4 report recurrence rates that range from 25% to 97%. As a result, these ulcers are classified as complex wounds and their management is considered a challenge. 5 Treatment of such complex wounds remains controversial. Despite the diversity of clinical approaches that have been proposed so far, which include simple topical care as well as high technology dressings, 6 recurrence rates are still high during the first year post-treatment. 7,8 Several systemic therapies also have been tested, such as zinc replacement, 9 use of antibiotics, 10 pentoxiphylin, 11 and blood transfusions. 12 However, in the authors clinical experience, even with the systemic stabilization of the anemia, these approaches have not produced substantial changes in the wounds, which continue to present raw surface areas and necrosis. Trying to determine the cost and outcomes of care in patients with sickle-cell anemia wounds, Cackovic et al 13 performed a retrospective study of 18 patients using various modalities over a mean duration of 53.7 months. No consistent results were found in the treatment of sickle-cell leg ulcers, but moist dressings pro- Dr. Paggiaro is an attending plastic surgeon, Plastic Surgery Division; Dr. Carvalho is a Scientific Research Advisor; Dr. Fonseca is an attending physician in hematology; Dr. Doi works in the Plastic Surgery Division; Dr. Ferreira is Full Professor and Chairman, Hospital das Clinicas, Plastic Surgery Division, Faculdade de Medicina da Universidade de Sao Paulo (FMUSP), Sao Paulo, Brazil. Please address correspondence to: Viviane Fernandes de Carvalho, PhD, ETN, Av.: Dr Arnaldo, 455 Room 1363 CEP: ; vivianefcarvalho@usp.br. 24 OSTOMY WOUND MANAGEMENT AUGUST
2 vided the best outcomes. Some case reports 6 propose the use of surgical debridement and skin grafting without any kind of wound bed preparation. Although initial results are positive, recurrence rates were high, although the study does not specify exactly how high. A case series by Weinzweig et al 14 reported use of microsurgical flaps in five patients with sickle cell ulcers but some ulcers recurred at an unspecified rate. Recently, negative pressure therapy (NPT) has been used to prepare the wound bed for skin graft. Horch et al 15 reported a case series of 21 multimorbid patients, 46 to 80 years of age, with severe lower limb soft tissue loss and infection with exposed bone. Repeated surgical debridement was followed by vacuum-assisted closure therapy at 125 mm Hg continuous mode and subsequent split-thickness skin grafting procedures. In all 21 patients, the wounds healed without a free-flap transfer. The purpose of this case study is to describe the use of a similar protocol of care debridement, NPT, and skin grafting on a patient with a sickle-cell ulcer. Case Study Ms. C, 28 years of age, of African descent, with sickle-cell disease diagnosed in 1998 and no other comorbidities, was admitted to the chronic wound outpatient clinic of the Clinics Hospital of the Faculty of Medicine of the University of São Paulo (HCF- MUSP) in 2005 with nonhealing wounds of 5 years duration. At that time, she was receiving folic acid (hydroxyurea) and deferoxamine mesylate as part of the treatment for her disease. On March 15, 2007, Ms. C was hospitalized with three deep wounds located on the right medial malleolus (5 cm x 10 cm), left medial malleolus (5 cm x 10 cm), and left lateral malleolus (7 cm x 12 cm). All three wounds had tendon exposure and contained fibrin slough firmly adherent to the wound bed (see Figure 1). Ms. C received erythrocyte concentrates only on admission due to low hemoglobin levels (7.2g/dL). The wounds were debrided surgically on day 2 (March 16, 2007). As part of the wound bed preparation, the left lateral malleolus wound was covered with a rayon and normal saline solution (0.9%) dressing, the left medial malleolus wound received a calcium alginate dressing covered by gauze, and the right medial malleolus wound was treated with NPT (125 mm Hg pressure in continuous mode) (see Figure 2). The idea was to evaluate the potential benefits of three different wound bed preparation approaches. On day 3, the rayon dressing was removed and changed every day thereafter; the alginate dressing also was removed on day 3 and subsequently changed every 48 hours. NPT was applied for 7 days. On March 23, 2007, assessment of all wounds revealed satisfactory granulation tissue ie, red, beefy tissue with no exudate on the wound beds that had received alginate and NPT. The wound with the rayon dressing had a considerable amount of fibrin and required a second debridement. Macroscopic analysis showed that, compared to the other wounds, the NPT-treated NEGATIVE PRESSURE AND SICKLE CELL DISEASE Ostomy Wound Management 2010;56(8):xx-xx Key Points A wide variety treatments and outcomes have been reported for the management of lower leg ulcers in persons with sickle-cell anemia. Stabilization of the anemia is important but most ulcers still require a long time to heal. The authors of this case study describe the outcome of three different treatments used in one patient with sickle-cell anemia and three lower leg ulcers. All ulcers were grafted and eventually healed but the differences observed suggest that additional research into the effect of topical treatment modalities on these wounds is warranted. wound bed had a more homogeneous surface, with better vascularization (see Figure 3). A split-thickness meshed skin graft (1:1.5) was removed with an electric dermatome from the donor site on the right thigh. The donor site was covered with transparent polyurethane film and the applied skin graft covered with a tie-over dressing. All wounds received skin grafts. Ms. C was transferred to the intensive care unit (ICU) on the second day after surgery due to severe post-transfusion hemolysis, which was treated with transfusion of erythrocyte concentrate, corticosteroids, and heparin. She stayed in the ICU for 5 days for stabilization. Six days after surgery, the grafted areas were exposed, showing complete integration of all grafts. Ms. C was discharged from hospital after 30 days, to continue follow-up in the outpatient clinic (see Figure 4). Approximately 9 months after treatment, the wounds on the left lateral and medial malleoli reappeared and were resistant to the usual clinical therapy of saline-soaked gauze. However, the graft on the wound treated with NPT remained intact. On January 16, 2008, the two fibrinous wounds on the left lateral and medial malleolus measured 7 cm x 5 cm. The wound beds were prepared for grafting using NPT (125 mm Hg, continuous mode) and the surgical procedure repeated. On January 24, 2008, the skin grafting was performed (meshed, 1:1.5). The grafts were completely integrated and Ms. C was discharged in 15 days (see Figure 5), without complications or transfusions. She attended the outpatient clinic for follow-up until October 15, 2009, without any recurrent wounds (see Figure 6). Discussion It is estimated that more than 2 million people in Brazil have the hemoglobin S gene and more than 8,000 have the severe form of sickle-cell disease (homozigosity). Every year, approximately 700 to 1,000 new cases of sickle-cell disease are diagnosed. 16 HCFMUSP has 343 registered sickle-cell disease patients, of which 31 are followed-up in the Complex Wound Outpatient Clinic due to lower limb ulcers. All 31 patients have had their AUGUST 2010 OSTOMY WOUND MANAGEMENT 25
3 Figure 1. March 15, 2007: three deep wounds A) right medial malleolus (5 cm x 10 cm); B) left medial malleolus (5 cm x 10 cm); C) left lateral malleolus (7 cm x 12 cm). Figure 2. March 16, 2007: A) surgical debridement performed as part of the wound bed preparation; B) negative pressure therapy (NPT) applied to the wound located on the right medial malleolus. wounds for at least 3 years, and in many cases, the wounds have not responded to topical and/or systemic treatment. The patient described in this study presented one of the most serious cases followed in the authors clinic; the patient had a 5- year history of three deep nonhealing wounds, with necrosis, multiple infections, severe pain, and no response to any kind of therapy. The wounds also were affecting the biomechanics of both lower limbs, impairing ambulation. Before grafting, a rayon dressing with normal saline, a calcium alginate dressing, and NPT were provided, one approach per wound. All three wounds healed successfully, and their grafts showed complete integration. However, right from the start, a difference was noted in the quality of the granulation tissue formed on the wound bed of the NPT-treated wound. The granulation tissue had an even surface, which resulted in a cleaner, more superficial, and reddish healthy-looking wound bed. The lesion that received normal saline needed a second debridement before grafting. Other authors have had similar difficulties preparing the wound bed of this kind of lesion; when simple surgical debridement was not enough, different dressings were tried. 8 Rayon with normal saline solution may not be able to maintain a favorable 26 OSTOMY WOUND MANAGEMENT AUGUST
4 environment to stimulate granulation, facilitating the resurgence of necrotic tissue. The wound that received the calcium alginate did not require a second debridement. A review of the literature 17 suggests that calcium alginate provides a moist microenvironment, facilitating cell proliferation and formation of granulation tissue. This could explain why additional debridement was unnecessary. Although no difference between the three wounds was observed regarding graft take, the wound treated with NPT was the NEGATIVE PRESSURE AND SICKLE CELL DISEASE Figure 3. March 23, 2007: reassessment of the wounds revealed satisfactory granulation tissue on the wound beds that had received A) NPT and B) and alginate; wound with the rayon dressing had a considerable amount of necrotic tissue (C2), which demanded a second debridement procedure (C1). Figure 4. March 30, 2007: 6 days after surgery, the grafted areas were exposed, showing complete integration of all grafts: A) right medial malleolus; B) left medial malleolus; C) left lateral malleolus. only one that had not recurred at the last follow-up visit, 11 months after surgery. The other two wounds recurred and required surgical intervention. In addition, during the follow-up period, while all wounds were still closed, the skin on the NPTtreated wound appeared more resilient and pliable than the others. This is the first study to date describing NPT used in a patient with sickle-cell anemia. The question could be raised whether the NPT-treated wound achieved the best results because that wound was less severe than AUGUST 2010 OSTOMY WOUND MANAGEMENT 27
5 Figure 5. Nine months after treatment, the wounds on the left medial (B1) and lateral (C1) malleoli reappeared. The graft on the wound treated with NPT (A1 and A2 right medial malleolus) remained intact. January 16, 2008: wounds on the left medial (B2) and lateral (C2) malleoli, with plenty of necrotic tissue. The wound bed was prepared with NPT and the surgical procedure repeated. the other two. However, after the recurrence of the ulcers in the other leg, NPT was used to prepare the wound bed for a new graft and no recurrence was observed so far. The optimal treatment for ulcers in patients with sickle-cell disease remains obscure due to the lack of controlled randomized studies; however, the results of this case study confirm previous reports suggesting that these wounds respond better in the presence of a moist wound environment. 13 The encouraging outcome suggests that research to explore the safety and effectiveness of NPT in patients with sickle-cell wounds is warranted. Conclusion In a case study of a 28-year-old African women with sicklecell disease and three complex chronic wounds, using NPT before skin grafting resulted in a healed wound with no recurrence thus far; whereas, wounds on the contralateral leg managed with saline-moistened rayon or a calcium alginate dressing before grafting recurred after 9 months. Studies to increase understanding about the potential role of NPT in the management of wounds in patients with sickle-cell disease are needed. n 28 OSTOMY WOUND MANAGEMENT AUGUST
6
7 Figure 6. September 18, 2009: no recurrent wounds A) right medial malleolus; B) left medial malleolus; C) left lateral malleolus. References 1. Paladino SF. Úlcera de membros inferiores na anemia falciforme. Rev Bras Hematol Hemoter. 2007;29: Eckman JR. Leg ulcers in sickle cell disease. Hematol Oncol Clin North Am. 1996;10: Gordon S, Bui A. Human skin equivalent in the treatment of chronic leg ulcers in sickle cell disease patients. J Am Podiatr Med Assoc. 2003;93(3): Trent JT, Kirsner RS. Leg ulcers in sickle cell disease. Adv Skin Wound Care. 2004;17: Ferreira MC, Tuma P Jr, Carvalho VF, Kamamoto F. Complex wounds. Clinics. 2006;61: Reindorf CA, Walker-Jones D, Adekile AD, Lawal O, Oluwole SF. Rapid healing of sickle cell leg ulcers treated with collagen dressing. J Natl Med Assoc. 1989;81: Schleucher R, Gaessler M, Knobloch J. Rapid healing of a late diagnosed sickle cell leg ulcer using a new combination of treatment methods. J Wound Care. 2007;16: Ballas SK. Sickle cell anaemia: progress in pathogenesis and treatment. Drugs. 2002;62: Sergeant GR, Galloway RE, Gueri MC. Oral zinc sulphate in sickle-cell ulcers. Lancet. 1970;2: Baum KF, MacFarlane DE, Maude GH, Sergeant GR. Topical antibiotics in chronic sickle cell leg ulcers. Trans R Soc Trop Med Hyg. 1987;81: Frost ML, Treadwell P. Treatment of sickle cell leg ulcers with pentoxifylline. Int J Dermatol. 1990;29: Fried M, Golan J, Moshe F. Treatment of leg ulcers in sickle cell disease. Blood. 1990:75: Cackovic M, Chung C., Bolton LL, Kerstein MD. Leg ulceration in the sickle cell patients. J Am Coll Surg. 1998;187: Weinzweig N, Schuler J, Marschall M, Koshy M. Lower limb salvage by microvascular free-tissue transfer in patients with homozygous sickle cell disease. Plast Reconstr Surg. 1995;96: Horch RE, Dragu A, Lang W, et al. Coverage of exposed bones and joints in critically ill patients: lower extremity salvage with topical negative pressure therapy. J Cutan Med Surg. 2008;12: Silva MC, Shimauti ELT. Effectiveness and toxicity of hydroxyurea in children with sickle cell anemia. Rev Bras Hematol Hemoter. 2006;28: Argenta LC, Morykwas MJ. Vacuum-assisted closure: a new method for wound control and treatment: clinical experience. Ann Plast Surg. 1997;38: OSTOMY WOUND MANAGEMENT AUGUST
Management of Complex Avulsion Injuries of the Dorsum of the Foot and Ankle in Pediatric Patients by Using Local Delayed Flaps and Skin Grafts
Management of Complex Avulsion Injuries of the Dorsum of the Foot and Ankle in Pediatric Patients by Using Local Delayed Flaps and Skin Grafts Ahmed Elshahat, MD Plastic Surgery Department, Ain Shams University,
More informationFournier's gangrene: skin grafting and negative pressure dressing
BJU International 2001 88 (1), 124 CASE REPORTS Fournier's gangrene: skin grafting and negative pressure dressing F. Schonauer, S. Grimaldi*, J.A. Pereira, G. Molea and G. Barone* Plastic Surgery Unit,
More informationAppropriate Dressing Selection For Treating Wounds
Appropriate Dressing Selection For Treating Wounds Criteria to Consider for an IDEAL DRESSING Exudate Management Be able to provide for moist wound healing by absorbing exudate or adding moisture Secure
More informationAcute and Chronic WOUND ASSESSMENT. Wound Assessment OBJECTIVES ITEMS TO CONSIDER
WOUND ASSESSMENT Acute and Chronic OBJECTIVES Discuss classification systems and testing methods for pressure ulcers, venous, arterial and diabetic wounds List at least five items to be assessed and documented
More informationDO NOT DUPLICATE. Negative pressure wound therapy (NPWT) has revolutionized the
Original research WOUNDS 2013;25(4):89 93 From the Aesthetic and Plastic Surgery Institute, University of California Irvine, Orange, CA and Long Beach Memorial Medical Center, Long Beach, CA Address correspondence
More informationDressings do not heal wounds properly selected dressings enhance the body s ability to heal the wound. Progression Towards Healing
Dressings in Wound Care: They Do Matter John S. Steinberg, DPM FACFAS Associate Professor, Department of Plastic Surgery Georgetown University School of Medicine Dressings do not heal wounds properly selected
More informationRole of free tissue transfer in management of chronic venous ulcer
Original Article Role of free tissue transfer in management of chronic venous ulcer K. Murali Mohan Reddy, D. Mukunda Reddy Department of Plastic Surgery, Nizams Institute of Medical Sciences, India. Address
More informationThe Georgetown Team Approach to Diabetic Limb Salvage: 2013
The Georgetown Team Approach to Diabetic Limb Salvage: 2013 John S. Steinberg, DPM FACFAS Associate Professor, Department of Plastic Surgery Georgetown University School of Medicine Disclosures: None Need
More informationUse of an Acellular Regenerative Tissue Matrix Over Chronic Wounds
Use of an Acellular Regenerative Tissue Matrix Over Chronic Wounds D. Heath Stacey, MD Northwest Arkansas Center for Plastic Surgery, Fayetteville, Ark Correspondence: dheathstacey@gmail.com Keywords:
More informationNegative pressure therapy (vacuum) for wound bed preparation among diabetic patients: case series
Case series Negative pressure therapy (vacuum) for wound bed preparation among diabetic patients: case series Terapia por pressão negativa (vácuo) no preparo do leito da ferida em pacientes diabéticos:
More informationCHAPTER 16 LOWER EXTREMITY. Amanda K Silva, MD and Warren Ellsworth, MD, FACS
CHAPTER 16 LOWER EXTREMITY Amanda K Silva, MD and Warren Ellsworth, MD, FACS The plastic and reconstructive surgeon is often called upon to treat many wound problems of the lower extremity. These include
More informationNanogen Aktiv. Naz Wahab MD, FAAFP, FAPWCA Nexderma
Nanogen Aktiv Naz Wahab MD, FAAFP, FAPWCA Nexderma Patient BM 75 y.o female with a history of Type 2 Diabetes, HTN, Hypercholesterolemia, Renal insufficiency, Chronic back Pain, who had undergone a L3-L4
More informationSurgical Management of wounds, flaps, grafts, and scars
Disclosures Surgical Management of wounds, flaps, grafts, and scars I have no financial disclosures Cherrie Heinrich, MD, FACS Department of Plastic Surgery Regions Hospital Assistant Professor University
More informationSingle-Stage Full-Thickness Scalp Reconstruction Using Acellular Dermal Matrix and Skin Graft
Single-Stage Full-Thickness Scalp Reconstruction Using Acellular Dermal Matrix and Skin Graft Yoon S. Chun, MD, a and Kapil Verma, BA b a Division of Plastic and Reconstructive Surgery, Department of Surgery,
More information1/5. Introduction. Primary endpoint Time to reach readiness for closure by surgical intervention or left for closure by secondary intention
1/5 Introduction Materials and methods Animal studies show that intermittent NPWT has potential to increase the rate of granulation tissue formation compared with adjustable intermittent (AI) NPWT 1 However,
More informationA Retrospective Comparison of Perforator and Rotation Flaps for the Closure of Extensive Stage IV Sacral Pressure Ulcers
A Retrospective Comparison of Perforator and Rotation Flaps for the Closure of Extensive Stage IV Sacral Pressure Ulcers Masaki Fujioka, MD, PhD; Kenji Hayashida, MD; Sin Morooka, MD; and Hiroto Saijo,
More informationA New Approach To Diabetic Foot Ulcers Using Keratin Gel Technology
A New Approach To Diabetic Foot Ulcers Using Keratin Gel Technology Farheen Walid, BA, Shrunjay R. Patel, BSc, Stephanie Wu, DPM, MS Center for Lower Extremity Ambulatory Research (CLEAR), Scholl College
More informationJMSCR Vol 06 Issue 04 Page April 2018
www.jmscr.igmpublication.org Impact Factor (SJIF): 6.379 Index Copernicus Value: 71.58 ISSN (e)-2347-176x ISSN (p) 2455-0450 DOI: https://dx.doi.org/10.18535/jmscr/v6i4.15 Study of Vaccum Assisted Closure
More informationCASE 1: TYPE-II DIABETIC FOOT ULCER
CASE 1: TYPE-II DIABETIC FOOT ULCER DIABETIC FOOT ULCER 48 YEAR-OLD MALE Mr. C., was a 48-year old man with a history of Type-II diabetes over the past 6 years. The current foot ulcer with corresponding
More informationNegative Pressure Wound Therapy
Origination: 6/29/04 Revised: 8/24/16 Annual Review: 11/10/16 Purpose: To provide Negative Pressure Wound Therapy (wound care treatment) guidelines for the Medical Department staff to reference when making
More informationA comprehensive study on effect of collagen dressing in diabetic foot ulcer
Original Research Article A comprehensive study on effect of collagen dressing in diabetic foot ulcer Sivakumar 1, S. Shanmugam 2* 1 Associate Professor, 2 Senior Assistant Professor Department of General
More informationAdjunctive Therapies: The Use of Skin Substitutes and Growth Factors in Venous Leg Ulceration (VLU)
Adjunctive Therapies: The Use of Skin Substitutes and Growth Factors in Venous Leg Ulceration (VLU) Sami Khan, MD FACS Associate Professor of Surgery Division of Plastic and Reconstructive Surgery SUNY-Stony
More informationJournal of American Science 2014;10(12) Vacuum assisted closure [VAC] in management of diabetic foot
Vacuum assisted closure [VAC] in management of diabetic foot Hisham W. Anwar 1 and Ayman A. Al-Tramsy 2 1 Department of General Surgery, Faculty of Medicine, Al-Azhar University, Cairo, Egypt 2 Department
More informationRegenerative Tissue Matrix in Treatment of Wounds
Regenerative Tissue Matrix in Treatment of Wounds Learning Objectives Differentiate between reparative and regenerative healing Review surgical techniques for applying a regenerative tissue scaffold to
More informationConsider the possibility of pressure ulcer development
Douglas Fronzaglia II, DO, MS LECOM Institute for Successful Aging LECOM Institute for Advanced Wound Care and Hyperbaric Medicine Consider the possibility of pressure ulcer development 1 Identify ulcer
More informationUse of Vacuum-assisted Wound Closure to Manage Limb Wounds in Patients Suffering from Acute Necrotizing Fasciitis
Original Article Use of Vacuum-assisted Wound Closure to Manage Limb Wounds in Patients Suffering from Acute Necrotizing Fasciitis Wen-Shyan Huang, Shang-Chin Hsieh, Chun-Sheng Hsieh, Jen-Yu Schoung and
More informationVacuum-Assisted Closure of Perineal War Wound Related to Rectum
Vacuum-Assisted Closure of Perineal War Wound Related to Rectum Nazım Gümüş, MD Plastic and Reconstructive Surgery Department, Adana Numune Research and Training Hospital, Adana, Turkey Correspondence:
More informationSource of effectiveness data The effectiveness evidence was derived from a review of published studies.
Cost and cost effectiveness of venous and pressure ulcer protocols of care Kerstein M D, Gemmen E, van Rijswijk L, Lyder C H, Phillips T, Xakellis G, Golden K, Harrington C Record Status This is a critical
More informationTransmetatarsal amputation in an at-risk diabetic population: a retrospective study
The Journal of Diabetic Foot Complications Transmetatarsal amputation in an at-risk diabetic population: a retrospective study Authors: Merribeth Bruntz, DPM, MS* 1,2, Heather Young, MD 3,4, Robert W.
More informationCase study: A targeted approach to healing complex wounds using the geko device.
Case study: A targeted approach to healing complex wounds using the geko device. Authors: Mr Sameh Dimitri Consultant Vascular and Endovascular Surgeon MSc FRCS (Eng Edin) Nikki Pavey Physiotherapist at
More informationBASICS OF BURN MANAGEMENT
BASICS OF BURN MANAGEMENT Dr S M Keswani Cosmetic Surgeon National Burns Centre, Airoli,Navi-Mumbai Breach Candy Hospital Wockhardt Hospital National Burns Centre, Airoli, Navi-Mumbai. CLASSIFICATION 1.
More informationLower Extremity Wound Evaluation and Treatment
Lower Extremity Wound Evaluation and Treatment Boni-Jo Silbernagel, DPM Describe effective lower extremity wound evaluation and treatment. Discuss changes in theories of treatment in wound care and implications
More informationInteresting Case Series. Fournier s Gangrene and the Reconstructive Challenges for the Plastic Surgeon
Interesting Case Series Fournier s Gangrene and the Reconstructive Challenges for the Plastic Surgeon David Izadi, MB, BChir, MA(Oxon), MA(Cantab), MRCS, James Coelho, BMBS, MSc, MRCS, Sameer Gurjal, MBBCh,
More informationNegative pressure wound therapy in surgical wounds: a prospective comparative study
International Surgery Journal Chandrashekar S et al. Int Surg J. 2017 Oct;4(10):3272-3276 http://www.ijsurgery.com pissn 2349-3305 eissn 2349-2902 Original Research Article DOI: http://dx.doi.org/10.18203/2349-2902.isj20174102
More informationUse of Non-Contact Low Frequency Ultrasound in Wound Care
Use of Non-Contact Low Frequency Ultrasound in Wound Care BLAIRE CHANDLER SEPTEMBER 29, 2015 VCU DPT CLASS OF 2016 Objectives Patient case overview Examine clinical evidence Review intervention of interest
More informationUncovering the Pressure Ulcer Coverup Rhonda Kistler RN MS CWON Wound Care Concepts Gentell
Uncovering the Pressure Ulcer Coverup Rhonda Kistler RN MS CWON Wound Care Concepts Gentell Objectives Identify the stages of pressure ulcer according to the depth of tissue destruction. Discuss the differences
More informationAssisted Living Resident Assessment (To be used when yes is indicated for skin issues under Section 5 of Assisted Living Resident Assessment)
Skin Assessment Current open skin areas: Yes No Current pressure ulcer: Yes No A. Stage 1 Ulcers Report based on highest stage of existing ulcers at its worst; do not reverse stage. Number of existing
More informationDetermining Wound Diagnosis and Documentation Tips Job Aid
Determining Wound Diagnosis and Job Aid 1 Coding Is this a traumatic injury from an accident? 800 Codes - Injury Section of the Coding Manual Code by specific site of injury. Only use for accidents or
More informationTopical antimicrobials (antiseptics) Iodine, Silver, Honey
Topical antimicrobials (antiseptics) Iodine, Silver, Honey Iodine Honey Silver Enzymatic debridement Proteolytic enzyme, also called Proteinase Proteinase breaks the long chainlike molecules of proteins
More informationSupporting healthcare professionals in taking control of the infection risk with ACTICOAT Flex TAKE CONTROL. of the infection risk in chronic wound
Supporting healthcare professionals in taking control of the infection risk with ACTICOAT Flex TAKE CONTROL of the infection risk in chronic wound Introduction The impact of infection on patients is well
More informationPedicled Fillet of Leg Flap for Extensive Pressure Sore Coverage
Pedicled Fillet of Leg Flap for Extensive Pressure Sore Coverage Shareef Jandali, MD, and David W. Low, MD Division of Plastic Surgery, University of Pennsylvania Health System, Philadelphia Correspondence:
More informationDiabetic Foot Ulcer Treatment and Prevention
Diabetic Foot Ulcer Treatment and Prevention Alexander Reyzelman DPM, FACFAS Associate Professor California School of Podiatric Medicine at Samuel Merritt University Diabetic Foot Ulcers One of the most
More informationPUT YOUR BEST FOOT FORWARD
PUT YOUR BEST FOOT FORWARD Bala Ramanan, MBBS 1 st year vascular surgery fellow Introduction The epidemic of diabetes and ageing of our population ensures critical limb ischemia will continue to grow.
More informationInteresting Case Series. Skin Grafting in Pyoderma Gangrenosum
Interesting Case Series Skin Grafting in Pyoderma Gangrenosum Marco Romanelli, MD, PhD, Agata Janowska, MD, Teresa Oranges, MD, and Valentina Dini, MD, PhD Department of Dermatology, University of Pisa,
More informationJMSCR Vol 07 Issue 01 Page January 2019
www.jmscr.igmpublication.org Impact Factor (SJIF): 6.379 Index Copernicus Value: 79.54 ISSN (e)-2347-176x ISSN (p) 2455-0450 DOI: https://dx.doi.org/10.18535/jmscr/v7i1.36 Original Article A Study on the
More informationOF WOUNDS SENIOR AUDITOR CAROLINAS HEALTHCARE SYSTEM. AHIA 32 nd Annual Conference August 25-28, 2013 Chicago, Illinois
1 THE WACKY WORLD OF WOUNDS ERIN RYDELL SENIOR AUDITOR CAROLINAS HEALTHCARE SYSTEM AHIA 32 nd Annual Conference August 25-28, 2013 Chicago, Illinois www.ahia.org Carolinas HealthCare System 2 Carolinas
More informationCase Rep Dermatol 2016;8: DOI: / Published online: April 21, 2016
Published online: April 21, 2016 2016 The Author(s) Published by S. Karger AG, Basel 1662 6567/16/0081 0097$39.50/0 This article is licensed under the Creative Commons Attribution-NonCommercial 4.0 International
More informationVaccum-Assisted Closure Therapy in Split-Thickness Skin Graft on the Wound on the Contours of the Body
J Wound Management Res 2017 September;13(2):35-39 https://doi.org/10.22467/jwmr.2017.00171 pissn 2586-0402 eissn 2586-0410 Journal of Wound Management and Research Vaccum-Assisted Closure Therapy in Split-Thickness
More informationAgenda (45 minutes) Some questions for you. Which wound dressing? Dressing categories/types. Summary
Dressing selection Agenda (45 minutes) Some questions for you. Which wound dressing? Dressing categories/types Summary Which wound dressing poster Ref: Which wound dressing? Practice Nursing, September
More informationClinical teaching/experi ence. Lectures/semina rs/conferences Self-directed. learning. Clinical teaching/experi ence
Regional Medical Center (The MED) Plastic Surgery PGY-3 By the end of the Plastic Surgery at the MED, the PGY-3 residents are expected to expand and cultivate knowledge and skills developed during previous
More informationMr Zachary Moaveni Plastic Surgeon, Middlemore Hospital. Mr Adam Bialostocki Plastic Surgeon, Tauranga
Mr Zachary Moaveni Plastic Surgeon, Middlemore Hospital Mr Adam Bialostocki Plastic Surgeon, Tauranga Mr. Adam Bialostocki Plastic Surgeon Minor Burns First Aid Remove the burning agent / wet clothes
More informationOriginal Article Honey Dressing in Healing of Foot Ulcers Pak Armed Forces Med J 2018; 68 (1): Umar Bashir, Rasikh Maqsood, Hassan Shabbir,
Open Access Original Article Honey Dressing in Healing of Foot Ulcers Pak Armed Forces Med J 2018; 68 (1): 34-38 COMPARING NEGATIVE PRESSURE WOUND TREATMENT WITH HONEY DRESSING IN HEALING OF FOOT ULCERS
More informationVacuumed Assisted Closure
Vacuumed Assisted Closure Louise Morris Lead Nurse in Tissue Viability Jackie Stephen-Haynes Consultant Nurse and senior Lecturer in Tissue Viability 2009 Aims and Objectives To develop an awareness of
More informationPlanning and outcome of soft tissue defects of the foot
206; 2(4): 47-423 ISSN: 2395-958 IJOS 206; 2(4): 47-423 206 IJOS www.orthopaper.com Received: -08-206 Accepted: 2-09-206 Dr. Shuaib Ahmed Dr. Latheesh Leo Hand and Microvascular Surgery, Department of
More informationDiscussion Topics. Calcium Alginates. DME For the Diabetic Foot 1/25/2017. Jeffrey D. Lehrman, DPM, FASPS, FACFAS, MAPWCA
DME For the Diabetic Foot Jeffrey D. Lehrman, DPM, FASPS, FACFAS, MAPWCA Editorial Advisory Board, WOUNDS Board of Directors, American Society of Podiatric Surgeons Board of Directors, American Professional
More informationCase Study. TRAM Flap Reconstruction with an Associated Complication. Repair using DermaMatrix Acellular Dermis.
Case Study TRAM Flap Reconstruction with an Associated Complication. Repair using DermaMatrix Acellular Dermis. TRAM Flap Reconstruction with an Associated Complication Challenge Insulin-dependent diabetes
More informationVenous Leg Ulcers. Care for Patients in All Settings
Venous Leg Ulcers Care for Patients in All Settings Summary This quality standard focuses on care for people who have developed or are at risk of developing a venous leg ulcer. The scope of the standard
More informationVACUUM ASSISTED CLOSURE (V.A.C.) THERAPY: Mr. Ismazizi Zaharudin Jabatan pembedahan Am Hospital Kuala Lumpur
VACUUM ASSISTED CLOSURE (V.A.C.) THERAPY: Mr. Ismazizi Zaharudin Jabatan pembedahan Am Hospital Kuala Lumpur Learning Objectives Define Negative Pressure Wound Therapy (NPWT) Discuss guidelines for the
More informationSee Policy CPT/HCPCS CODE section below for any prior authorization requirements
Effective Date: 7/1/2018 Section: DME Policy No: 377 Medical Officer 7/1/18 Date Technology Assessment Committee Approved Date: 10/10; 10/13; 9/14: 9/15; 4/16 Medical Policy Committee Approved Date: 3/03;
More informationDisclosures. Outpatient NPWT Options Free up Hospital Beds, but Do They Work? Objectives. Clinically Effective: Does it Work?
4/16/16 Disclosures Consultant, Volcano Corporation Outpatient Options Free up Hospital Beds, but Do They Work? UCSF Vascular Symposium 16 Jonathan Labovitz, DPM Medical Director, Foot & Ankle Center Associate
More informationInteresting Case Series. A Case of Fournier s Gangrene
Interesting Case Series A Case of Fournier s Gangrene Anthony Maurice Kordahi, MD, and Ahmed S. Suliman, MD Division of Plastic Surgery, University of California San Diego Correspondence: kordahi.amk@gmail.com
More informationThe Open Orthopaedics Journal
Send Orders for Reprints to reprints@benthamscience.ae 704 The Open Orthopaedics Journal, 2017, 11, (Suppl-4, M11) 704-713 The Open Orthopaedics Journal Content list available at: www.benthamopen.com/toorthj/
More informationAnseong Factory : 70-17, Wonam-ro, Wongok-myeon, Anseong-si, Gyeonggi-do , REPUBLIC OF KOREA
Care for tomorrow The Solution for Management HQ & Factory : 7, Hyeongjero4Beon-gil, Namsa-myeon, Cheoin-gu, Yong-in-si, Gyeonggi-do 449-884, REPUBLIC OF KOREA TEL: +8-3-33-33 / FAX: +8-3-33-34 Anseong
More informationInteresting Case Series. Scalp Reconstruction With Free Latissimus Dorsi Muscle
Interesting Case Series Scalp Reconstruction With Free Latissimus Dorsi Muscle Danielle H. Rochlin, BA, Justin M. Broyles, MD, and Justin M. Sacks, MD Department of Plastic and Reconstructive Surgery,
More informationFluorescence Angiography in Limb Salvage
Fluorescence Angiography in Limb Salvage Ryan H. Fitzgerald, DPM, FACFAS Associate Professor of Surgery-University Of South Carolina School of Medicine, Greenville Etiology of Lower extremity wounds Neuropathy
More informationFoam dressings have frequently
The practical use of foam dressings Efficient and cost-effective management of excessive exudate continues to challenge clinicians. Foam dressings are commonly used in the management of moderate to heavily
More informationSplit Hemianterior Tibialis Turndown Muscle Flap for Coverage of Distal Leg Wounds With Preservation of Function
Split Hemianterior Tibialis Turndown Muscle Flap for Coverage of Distal Leg Wounds With Preservation of Function Vinay Gundlapalli, MD, a John W. Gillespie III, MD, b and Chris D. Tzarnas, MD, FACS c a
More informationCorrespondence should be addressed to Domenico Pagliara;
Case Reports in Surgery, Article ID 783812, 4 pages http://dx.doi.org/10.1155/2014/783812 Case Report Reconstruction of Traumatic Defect of the Lower Third of the Leg Using a Combined Therapy: Negative
More informationReconstruction of axillary scar contractures retrospective study of 124 cases over 25 years
British Journal of Plastic Surgery (2003), 56, 100 105 q 2003 The British Association of Plastic Surgeons. Published by Elsevier Science Ltd. All rights reserved. doi:10.1016/s0007-1226(03)00035-3 Reconstruction
More informationWe are IntechOpen, the first native scientific publisher of Open Access books. International authors and editors. Our authors are among the TOP 1%
We are IntechOpen, the first native scientific publisher of Open Access books 3,350 108,000 1.7 M Open access books available International authors and editors Downloads Our authors are among the 151 Countries
More informationAdvancing the science of wound bed preparation
Advancing the science of wound bed preparation How Drawtex wound dressing works LevaFiber Technology provides three different types of action. Mechanisms of Action Capillary Action Hydroconductive Action
More informationChronic Wounds and Ulcers
1 Chapter 2 Chronic Wounds and Ulcers Louis Carter Chronic wounds are likely the greatest cause of morbidity and cost to both patients and hospitals in Africa. With more surgeons and the availability of
More informationClinical Policy: EpiFix Wound Treatment
Clinical Policy: Reference Number: PA.CP.MP.140 Effective Date: 03/18 Last Review Date: 04/18 Coding Implications Revision Log Description EpiFix (MiMedx Group) is dehydrated human amniotic tissue that
More informationPost-surgical wound management of pilonidal cysts by using a haemoglobin spray
Post-surgical wound management of pilonidal cysts by using a haemoglobin spray Nesat Mustafi 1 & Peter Engels 2 1 Wound center, Nordwest Hospital, Frankfurt, Germany, 2 Bergisch Gladbach, Germany Objective:
More informationISPUB.COM. S Saad, E Shakov, V Sebastian, A Saad INTRODUCTION METHODS CASE REPORT 2 CASE REPORT 3 CASE REPORT 1
ISPUB.COM The Internet Journal of Surgery Volume 11 Number 1 The use of Wound Vacuum-assisted Closure (V.A.C. ) system in the treatment of Recurrent or Complex Pilonidal Cyst Disease: Experience in 4 Adolescent
More informationINTRODUCTION TO WOUND DRESSINGS
WOUND CARE INTRODUCTION TO WOUND DRESSINGS JEC 2017 Wound Care Successfully completed specialized skills training in Wound Management. WOUND CONDITIONS & SYMBOLS BY COLOURS Yellow Black Necrotic tissue
More informationJonathan A. Dunne, MBChB, MRCS, a Daniel J. Wilks, MBChB, MRCS, b and Jeremy M. Rawlins, MBChB, MPhil, FRCS (Plast) c INTRODUCTION
CASE REPORT A Previously Discounted Flap Now Reconsidered: MatriDerm and Split-Thickness Skin Grafting for Tendon Cover Following Dorsalis Pedis Fasciocutaneous Flap in Lower Limb Trauma Jonathan A. Dunne,
More informationChest Wall Tumors and Reconstruction: Lateral Chest Wall. Dr. Robert Kelly
Chest Wall Tumors and Reconstruction: Lateral Chest Wall Dr. Robert Kelly THORACIC PROGRAMME: ADVANCES IN CHEST WALL SURGERY AND OSTEOSYNTHESIS Dr. José Ribas Milanez de Campos Assistant, Professor, Department
More informationNegative Pressure Wound Therapy (NPWT) Using On-shelf Products for Treatment of Post-Traumatic Wounds: A Case Series
Med. J. Cairo Univ., Vol. 80, No. 2, December: 87-93, 2012 www.medicaljournalofcairouniversity.com Negative Pressure Wound Therapy (NPWT) Using On-shelf Products for Treatment of Post-Traumatic Wounds:
More informationA comparative study of the effect on healing of ulcer using silver dressing
International Surgery Journal Khandelwal AK et al. Int Surg J. 2016 May;3(2):768-775 http://www.ijsurgery.com pissn 2349-3305 eissn 2349-2902 Research Article DOI: http://dx.doi.org/10.18203/2349-2902.isj20160493
More informationTOO MANY DRESSING CHOICES!!!! WOUND CARE MANAGEMENT AND PRODUCTS. Should Your Practice Dispense Wound Care Supplies? Pros:
WOUND CARE MANAGEMENT AND PRODUCTS Animesh Bhatia DPM, CWS, FAPWCA Board Certified Wound Specialist Diplomate, American Academy of Wound Management Fellow, American Professional Wound Care Association
More informationClinical Comparative Study of Aquacel and Paraffin Gauze Dressing for Split-Skin Donor Site Treatment
ORIGINAL ARTICLE Clinical Comparative Study of Aquacel and Paraffin Gauze Dressing for Split-Skin Donor Site Treatment Yoav Barnea, MD, Aharon Amir, MD, David Leshem, MD, Arik Zaretski, MD, Jerry Weiss,
More informationWOCN Document:
WOCN Document: www.cms.hhs.gov/medicaid/surveycert/080601.pdf OASIS Training Internet site: www.oasistraining.org M0440 Does this patient have a Skin Lesion or an Open Wound? This excludes "OSTOMIES."
More informationConcepts of Total Contact Cast(TCC) Negative Pressure Wound Therapy(NPWT)
Concepts of Total Contact Cast(TCC) & Negative Pressure Wound Therapy(NPWT) Chungnam National University Hospital Orthopaedic Surgery Chan Kang Total Contact Cast TTC on DM foot ulcer Risk classification
More informationClosure of Chronic Heel Ulcer by Simple V-Y Flap
Egypt, J. Plast. Reconstr. Surg., Vol. 40, No. 1, January: 97-101, 2016 Closure of Chronic Heel Ulcer by Simple V-Y lap ESA TAAN,.D.; AYAN ARHAT,.D.; OUSTAA EKY,.D. and AHOUD NASI,.D. The Department of
More informationEffectiveness of vacuum assisted negative pressure wound therapy in grossly contaminated wounds
2018; 4(1): 401-405 ISSN: 2395-1958 IJOS 2018; 4(1): 401-405 2018 IJOS www.orthopaper.com Received: 20-11-2017 Accepted: 21-12-2017 Sumit Kumar Mohd Bilal Kaleem Misbah Mehraj Senior Resident, Department
More informationYour guide to wound debridement and assessment. Michelle Greenwood. Lorraine Grothier. Lead Nurse, Tissue Viability, Walsall Healthcare NHS Trust
Your guide to wound debridement and assessment Michelle Greenwood Lead Nurse, Tissue Viability, Walsall Healthcare NHS Trust Lorraine Grothier Clinical Nurse Specialist, Tissue Viability, Central Essex
More informationCURRENT CONCEPTS IN PRESSURE INJURY PREVENTION AND CARE
CURRENT CONCEPTS IN PRESSURE INJURY PREVENTION AND CARE JOIE WHITNEY, PHD, RN, CWCN, FAAN PROFESSOR BIOBEHAVIORAL NURSING AND HEALTH SYSTEMS UNIVERSITY OF WASHINGTON HARBORVIEW ENDOWED PROFESSOR IN CRITICAL
More informationCase 1. July 14, th week wound gel 3 cm x 2.5 cm = 7.5 cm². May 25, st wound gel on 290 days PI treatment 4 cm x 2.4 cm = 9.
2.5% Sodium Hyaluronate Wound Gel Study Cases Case 1 Patient with Lower Leg Ulcer Not Responding to Compression This patient was a 50-year old male patient with nonhealing right lower leg since January
More informationIntegra. PriMatrix Dermal Repair Scaffold PATIENT INFORMATION. Questions? Contact us: Clinician: Phone #: In case of emergency, dial 9-1-1
Integra PriMatrix Dermal Repair Scaffold PATIENT INFORMATION Questions? Contact us: Clinician: Phone #: In case of emergency, dial 9-1-1 Your Path to Recovery Your health care provider has chosen to use
More informationAmerican Burn Association Burn Rehabilitation Therapist Competency Tool Version 2
This document is intended to establish a framework for basic practice standards related to burn rehabilitation and provide a common language for education programs to train burn rehabilitation therapists
More informationSimple, gentle and affordable. *smith&nephew V1STA Negative Pressure Wound Therapy
Simple, gentle and affordable *smith&nephew V1STA Negative Pressure Wound Therapy Smith & Nephew s extensive presence and portfolio means that for every wound, at every stage, there is an appropriate solution.
More informationHeel Defect Reconstruction using Local Vascularized Flaps: Results and Clinical Outcomes in 16 Patients
JFS (P) Kuldeep Singh et al ORIGINL RTICLE 10.5005/jp-journals-10040-1083 Heel Defect Reconstruction using Local Vascularized Flaps: Results and Clinical Outcomes in 16 Patients 1 Kuldeep Singh, 2 Zile
More informationDurable Medical Equipment Providers
August 2009 Provider Bulletin Number 974 Durable Medical Equipment Providers Vacuum Assisted Wound Closure Therapy Negative pressure wound therapy (NPWT) must be requested and supplied by an enrolled durable
More informationThe VERSAJET II Hydrosurgery System
Precise Excision The VERSAJET II Hydrosurgery System The VERSAJET II Hydrosurgery System The VERSAJET II system enables a surgeon to precisely select, excise and evacuate nonviable tissue, bacteria and
More informationSECTION M: SKIN CONDITIONS. M0210: Unhealed Pressure Ulcer(s) Item Rationale
SECTION M: SKIN CONDITIONS Intent: The items in this section of the April 1, 2014 release of the LTCH CARE Data Set Version 2.01 document the presence, appearance, and change of pressure ulcers. If warranted
More informationYonekura, Akihiko; Tomita, Masato;
NAOSITE: Nagasaki University's Ac Title Author(s) Citation Fournier's gangrene a case report Miyamoto, Takashi; Fukushima, Tatsu Yonekura, Akihiko; Tomita, Masato; Acta medica Nagasakiensia, 61(1), p Issue
More informationIf both a standardized, validated screening tool and an evaluation of clinical factors are utilized, select Response 2.
(M1300) Pressure Ulcer Assessment: Was this patient assessed for Risk of Developing Pressure Ulcers? 0 - No assessment conducted [Go to M1306 ] 1 - Yes, based on an evaluation of clinical factors (for
More informationClinical Policy Title: Vacuum assisted closure in surgical wounds
Clinical Policy Title: Vacuum assisted closure in surgical wounds Clinical Policy Number: 17.03.00 Effective Date: September 1, 2015 Initial Review Date: June 16, 2013 Most Recent Review Date: August 17,
More information