KCI Connect. Healing. Possible More than 10,000 patients have benefitted from V.A.C. Therapy in India. * MADE of Healing TM. Volume 4 : Issue 1

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1 KCI Connect of Healing TM Volume 4 : Issue 1 KCI Connect is intended for healthcare professionals only in India. Welcome to the summer edition of KCI Connect. It s been 9 months since KCI began operating directly in India. Our operational capabilities have never been better, with dedicated, competent and well-trained teams, new infrastructure and Customer Service. At KCI, we believe acting responsibly and giving back to society is as important as running our own business. We are happy and proud to be making a positive change and difference towards treating and managing wounds. We commenced 2013 with a strong sense of purpose and ambition. The need to keep the momentum moving forward with ambition and enthusiasm places a significant challenge to all of us at KCI, who have been extremely proactive. We are proud to say that we have been able to keep up with our commitment in providing excellent service through unmatched Clinical support. We will continue to strive hard to provide you with the best quality products and outstanding clinical support. We do take this opportunity to share with you that the KCI Clinical Support and Training team has trained over 100 Nursing Staffs associated with various hospitals on V.A.C. Dressing. As part of our professional education Training plans for the year 2013, we plan to train at least 1,000 Paramedical Staff on V.A.C. Therapy. I am excited to announce the new addition to our product portfolio with the launch of ActiV.A.C. Therapy System, the light and portable V.A.C. Therapy system which leads by its design. ActiV.A.C. Therapy will enable the patients to be mobile without interfering with the benefits of V.A.C. Therapy and their normal daily activities. Surf through the newsletter to get more details of ActiV.A.C. Therapy and its benefits. In pursuit of improving the lives of our customers and the community in general, I am delighted to inform you about the geographical expansion and initiation of our operation in important cities like Pune, Ahmedabad, Hyderabad and Kolkata. Now customers in these cities can also benefit from the technological advancement in wound management with our V.A.C. Therapy System. I assure you we will provide the same kind of unmatched clinical support and services as we have exhibited in the other regions. Finally, this issue of the KCI connect Newsletter introduces three new case studies from eminent surgeons from various field of Plastic, Vascular and Trauma. Case 1: Diabetic Foot Ulcer Dr. S. Ganapathy Krishnan, MS, Mch., Senior Consultant Plastic and Reconstuctive Surgeon Apollo Hospitals, Chennai. Case 2: V.A.C. Therapy in a Geriatric Patient with Multiple Co-Morbidities Dr. R. Shekar, MS, FRCSEd, FRCS (Glasgow) Consultant Vascular & Endovascular Services, Kokilaben Dhirubhai Ambani Hospital & Medical Research Institute, Mumbai Case 3: Multiple Trauma Injuries Dr. N. Jithendran, DNB, Ms. MCh Aware Global Hospitals, Hyderabad A relevant section, which also must be highlighted, is the interesting article on ActiV.A.C. Therapy - the newly launched portable V.A.C. Therapy System and advantages of our special V.A.C. GranuFoam TM Bridge dressings. We trust you will find this issue interesting and informative, and we would personally like to thank everyone who has supported this edition by providing challenging case studies. We are looking forward to continuing this productive channel of information exchange throughout the medical fraternity related to wound management. The future success of this newsletter depends on your comments, contributions and ideas! We do encourage all of you to enrich the forthcoming KCI Connect Newsletters! Sajiv S General Manager Healing MADE Possible More than 10,000 patients have benefitted from V.A.C. Therapy in India. * * As of March, KCI India data on file

2 Case Study: Diabetic Foot Ulcer Figure 3. V.A.C. Therapy initiated Figure 6. Cavity closed Dr. S. Ganapathy Krishnan MS, Mch., Senior Consultant Plastic and Reconstuctive Surgeon Apollo Hospitals, Chennai the region of previous bone exposure (Fig 4). An X-ray showed osteomyelitis of the tarsal bones, for which the patient underwent curettage. This resulted in a deep cavity in the mid foot (Fig 5). Once again, V.A.C. Therapy was applied, and over the next few weeks, the cavity had covered completely (Fig 6) and the wound had epithelialised Discussion Presentation & History A 48-yr old female diabetic patient presented to the hospital with a chronic sloughing ulcer on the lateral aspect of the foot (Fig 1) which had resulted following debridement of skin necrosis in another hospital. The patient was initially managed by a vascular surgeon in view of poor vascularity of the limb and underwent several debridements for cellulitis and necrosis of the dorsal foot tissues. As the wound was non-healing, with a likelihood of resulting in an amputation, a plastic surgery consult was requested. On examination, she had a large raw area over the dorsum of foot extending to the ankle and lower leg, which exposed sloughing non-viable extensor tendons and minimal exposure of the mid-tarsal bones ( Fig 2). She also had a relatively clean granulating wound on the lateral aspect of the foot (previous debridement). Treatment Plan Ideally, she should have had a microvascular free tissue transfer to the dorsum of the foot in view of the exposed tendons and tarsal bones. However, considering the poor vascular status of the limb, it would have been associated with some complications of failure of the flap. The patient was not very receptive to having a major surgical procedure; neither was she willing for an amputation. Therefore, it was decided to initiate V.A.C. Therapy with the aim to try to preserve the limb and increase granulation tissue in the wound in order to prepare the wound for a skin graft. Initiating V.A.C. Therapy V.A.C. Therapy (-125 mmhg in a continuous mode) was started over both the dorsal and lateral wounds after a stage of thorough debridement (Fig 3). Since the two wounds were separated by an area of intact skin, a bridging technique was utilized after taking care to protect the periwound intact skin. Resurfacing of diabetic wounds is a major challenge to the plastic surgeon, especially when the wounds are on the foot where the reconstructive options are limited due to paucity of local tissues. Most often they demand a free flap cover which is also associated with its own complications in view of the poor vasculature of these diabetic patients. In difficult situations like the one described, V.A.C. Therapy can be an excellent option, especially when amputation is contemplated. The use of V.A.C. Therapy helped promote granulation tissue formation, facilitating a simple skin graft. The development of osteomyelitis was a setback, especially with the presence of the deep cavity in the mid foot. This ideally would have required a muscle flap to fill the cavity.* Once again V.A.C. Therapy helped the cavity fill and heal completely without the need of a skin graft (Fig 7). The patient s foot was saved and she is presently ambulant on her own. Figure 1. Sloughing wound on lateral foot Figure 2. Wound on dorsum with exposed tendons* Figure 4. Skin grafted foot with non-healing wound over mid foot Figure 5. Cavity in mid foot followed curettage Figure 7. Wounds completely healed *Manufacturer s note: KCI Clinical Guidelines and the product labeling recommend the following: Tendons, ligaments, blood vessels, organs and nerves (vital structures) must be completely covered and protected prior to the administration of V.A.C. Therapy. Coverage with a muscle flap or other thick layer of natural tissue provides the most effective protection. If not available, consider using non-adherent porous material (i.e., fine mesh gauze) or bioengineered tissue. As with any case study, the results and outcomes should not be interpreted as a guarantee or warranty of similar results. Individual results may vary depending on the patient s circumstances and condition. NOTE: Specific indications, contraindications, warnings, precautions and safety information exist for KCI products and therapies. Please consult a physician and product instructions for use prior to application KCI Licensing, Inc. All rights reserved. Adapt is a trademark of Hollister Incorporated. All other trademarks designated herein are proprietary to KCI Licensing, Inc., its affiliates and/or licensors. This material is intended for healthcare professionals. DSL# IN (3/2013) Regular dressing changes were performed every 3-4 days for about 3 weeks. The wound granulated very well and was ready for a skin graft. V.A.C. Therapy was also applied post-ssg placement. Over the next couple of weeks, the 2 graft settled very well, except for a non-healing wound over 3

3 Case Study: V.A.C. Therapy in a Geriatric Patient with Multiple Co-Morbidities Figure 3. Wound 2 weeks post split thickness graft Figure 4. Appearance 2 months post split thickness skin graft Dr. R. Shekar MS, FRCSEd, FRCS (Glasgow) Consultant Vascular & Endovascular Services Kokilaben Dhirubhai Ambani Hospital & Medical Research Institute, Mumbai Case Highlights V.A.C. Therapy use in a geriatric patient with multiple co morbidities Accelerated and uncomplicated wound healing in a diabetic patient with additional metabolic deficits Wound healing in a critically ill patient with complications V.A.C. Therapy response without side effects while on anticoagulants Case Report: Presentation -125 mmhg in Continuous mode. Dressing changes were carried out as instructed by the treating surgeon, and progress of healing in the wound was documented. Wound Progress V.A.C. Therapy was initially instituted for 3 weeks, together with a 2-week course of systemic antibiotics, during which granulation tissue covered the wound; this was associated with a marked decrease in inflammation, edema, and pain. At the end of 3 weeks, the patient received a split-thickness graft as skin cover over the healing wound. V.A.C. Therapy was continued for a further 2 weeks until the wound healed completely, and the patient was advised compression stockings and oral anticoagulants thereafter. Post - V.A.C. Therapy Follow-up The patient has been followed up at regular intervals for 2 months, and the wound has healed completely without further complications. Figure 1. Initial wound presentation As with any case study, the results and outcomes should not be interpreted as a guarantee or warranty of similar results. Individual results may vary depending on the patient s circumstances and condition. NOTE: Specific indications, contraindications, warnings, precautions and safety information exist for KCI products and therapies. Please consult a physician and product instructions for use prior to application KCI Licensing, Inc. All rights reserved. Adapt is a trademark of Hollister Incorporated. All other trademarks designated herein are proprietary to KCI Licensing, Inc., its affiliates and/or licensors. This material is intended for healthcare professionals. DSL# IN (4/2013) Case Study: Multiple Trauma Injuries A 74-year-old female patient was admitted to the hospital with a non-healing wound on the medial aspect of her right leg just above the ankle. The wound had appeared nearly a month previously, after a thrombotic episode.there was marked inflammation and edema, and the patient reported severe pain at the site of the wound. In view of previous major surgeries in both legs where the patient had undergone total knee replacement, Doppler USG of both legs was advised and carried out. Results indicated the presence of old DVTs, but perfusion was ascertained to be adequate in both limbs. Complications The patient was an elderly diabetic on concurrent treatment for diabetes, hypothyroidism, and hypertension, but with adequate control for hypothyroidism and hypertension. Although on anticoagulants, the patient developed a massive pulmonary embolism, pericardial effusion, and features of right heart failure; for this, the patient underwent thrombolysis and surgery, and an IVC filter was inserted. Figure 2. Wound 3 weeks after V.A.C. Therapy initiation Dr. N. Jithendran DNB, Ms. MCh Aware Global Hospitals, Hyderabad Patient A 21-year-old male was admitted to the hospital after being injured in an accident while trying to catch a bus. Diagnosis The patient presented with a large area of soft-tissue loss over the right groin, hip and thigh (Figure 1). The anterior superior iliac spine was fractured, and the anterior iliac crest was exposed. Initial Treatment On March 9, 2011, the wounds were extensively debrided under general anesthesia (Figure 3). The wound on the right groin and hip was closed over a corrugated drain followed by initiation of V.A.C. Therapy. The wound over the right hand and forearm was also debrided, exposing the radius distal end and bases of the second and third metacarpal (Figure 3). A below-elbow synthetic plaster slab was also applied, and a free tissue transfer was planned. V.A.C. Therapy System Initiation V.A.C. Therapy was applied (Figure 4) to the right groin and hip wound for 14 days with continuous pressure at 125 mmhg, and dressing changes occurring every 4 days* in the operating room after repeated debridement. V.A.C. Therapy was stopped on Day 6 when the patient developed sepsis due to infection with gas-forming organisms and was treated with repeat debridement, high-end antibiotic coverage and anti-gas gangrene serum. Treatment for sepsis was successful and V.A.C. Therapy was subsequently reapplied for the remainder of the treatment period. Additionally, there was skin and soft tissue loss over the right hand and distal forearm with exposure to underlying radius and base of second and third metacarpal bones, as well as loss of EPL, ECRL and ECRB tendons and partial V.A.C. Therapy System Initiation loss of distal end of radius (Figure 2). Complications during hospital stay included sepsis as a result of infection with The leg wound was debrided, a V.A.C. GranuFoam TM gas forming organisms, hematochezia, and an episode of 4 Dressing was applied, then V.A.C. Therapy was initiated at hematuria. 5

4 Post-V.A.C. Therapy Follow-up After 14 days of V.A.C. Therapy, good granulation had formed over the right groin and thigh region (Figure 5), which was eventually skin grafted. A free tissue transfer of the anterolateral thigh (ALT) flap was used to cover exposed bones in the right hand. The patient was discharged shortly after successful free flap and skin graft take (Figure 6). Figure 3. Wounds after debridement under general anesthesia Figure 6. Successful graft take of rigt hip and thigh and a well-settled, thinned ALT flap cover over right hand and distal forearm. Bridge Dressings - Key Factors Product Features Wicking layers helps prevent maceration Allows for off loading treatment with the proven healing of V.A.C. Therapy Discussion Patient endured extensive wounds in his right upper and lower limbs. Right hand and forearm were successfully healed after a free tissue transfer. Right lower limb injuries were also successfully treated with debridement, V.A.C. Therapy, and skin grafting. *Note: KCI recommends dressing changes for V.A.C. Therapy every hours. Ease of Use Integrated bridge allows for SensaT.R.A.C. TM Pad placement away from the wound site Components designed to simplify dressing application Patient Quality of Life Helps promote mobility, allowing patients to resume activities of daily living Concomitant therapies provide benefits of off-loading and V.A.C. Therapy Facilitates patient transition to a non-acute care setting with an off-loading boot and V.A.C. Therapy Figure 1. Initial presentation of right groin, hip and thigh wound Figure 4. Application of V.A.C. Therapy As with any case study, the results and outcomes should not be interpreted as a guarantee or warranty of similar results. Individual results may vary depending on the patient s circumstances and condition. NOTE: Specific indications, contraindications, warnings, precautions and safety information exist for KCI products and therapies. Please consult a physician and product instructions for use prior to application KCI Licensing, Inc. All rights reserved. Adapt is a trademark of Hollister Incorporated. All other trademarks designated herein are proprietary to KCI Licensing, Inc., its affiliates and/or licensors. This material is intended for healthcare professionals. DSL# IN (4/2013) The bridge dressing is not limited to the foot; It is an ideal dressing when bridging is required with pressure injuries, e.g. on the sacrum, ischial tuberosity and greater trochanter, on the cervical spine under a collar. The dressing can be adapted to anywhere there is need to bridge away from the wound site and deliver NPWT at a distance. This dressing application is very quick to apply as it is ready to use. Figure 5. Wound showing good granulation over right hip and thigh after 14 days of V.A.C. Therapy Diabetic foot ulcers: Supports concomitant therapy Figure 2. Initial presentation of right upper limb wound The V.A.C. GranuFoam TM Bridge Dressing enables V.A.C. Therapy with an off-loading device simultaneously to help provide optimal outcomes for the diabetic foot wound. 6 7

5 The ActiV.A.C. Therapy System is Portable Negative Pressure Wound Therapy (NPWT) The ActiV.A.C. Therapy System has been designed to help patients resume their activities of daily living while still receiving the proven wound healing benefits of V.A.C. Therapy. This includes many new enhancements that make using V.A.C. Therapy easier for both patients and healthcare professionals. The features of this ergonomically designed therapy unit include: Lightweight. Weighs only 2.4 pounds Small size that can be worn close to the body Easy to use Alarm notifications that are easy to recognize and correct 14 hour battery Therapy history report documents patient compliance with V.A.C. Therapy Seal Check TM Feature Designed to help clinicians and patients identify and troubleshoot negative pressure leaks, Seal Check Feature provides: Instant Feedback. Audio and visual cues are delivered in real time, allowing easy location of dressing leaks Enhanced Therapy Confidence. A proper seal helps provide accurate delivery of prescribed therapy for optimal wound healing Possible Reduction of Unscheduled Visits. Patients can troubleshoot dressing leaks themselves. Easier for clinicians to help troubleshoot problems over the phone. Simplified Touch Screen Enhanced, simplified control functions: Easy Navigation. Features a full color interface with intuitive touch screen controls. Simplified Patient Mode. Control functions designed specifically for patients are easy to use and understand. Reduced Training. Shares common control functions with the InfoV.A.C. Therapy System for easier training through continuum of care. Settings Guide Recommended therapy settings and pressure ranges are pre programmed based on the indicated wound types, allowing for: Easy Set Up. With pre programmed settings by wound type, clinicians can initiate therapy quickly and efficiently Simple Usage. Intuitive control functions make it easier to use, especially for clinicians who are not as familiar with V.A.C. Therapy KCI Connect newsletter is Published by KCI Medical India Pvt. Ltd., #1007, 2 nd Floor, HAL 2 nd Stage, 13 th Main, 2 nd Cross, Indiranagar, Bangalore all correspondence to: darshana.patel@kci1.com KCI Medical India Pvt. Ltd., #1007, 2 nd Floor, 13 th Main, 2 nd Cross, HAL 2 nd Stage, Indiranagar, Bangalore Tel: / 01/ 02 Toll Free: For information on our products and solutions, visit the company s Web site at or us at kci-india.enquiries@kci-medical.com Design & Layout: Future Brite Communications Pvt. Ltd., Print run: 3,000 KCI Connect newsletter is distributed to KCI Medical customer and Business friends free of charge KCI Licensing, Inc. All rights reserved. The copyright, any and all trademarks and trade names and other intellectual property rights subsisting in or used in connection with and related to this publication are, unless another owner is specified, the property of KCI Licensing, Inc. No part of this publication may be reproduced, stored in a retrieval system, or transmitted, in any form or by any means, electronic, mechanical, photocopying, recording or otherwise, with out the prior written permission of KCI Licensing, Inc. DSL# IN (5/13) DISCLAIMER AND LIMITATION OF LIABILITY Whilst KCI Medical endeavors to provide on this publication accurate information, the articles may contain incomplete information, the information may contain errors or the information may be outdated. No representation of warranty of any kind, either express or implied, is or has been made as to the completeness, accuracy or reliability of the information in this publication or to the information or material of the third parties that may be published in this publication. Further the reader expressly acknowledges that the usage of reliance on the information contained in this publication is at the reader s own risk. KCI Medical shall not under any circumstances be liable for any direct, consequential, incidental, secondary or special damages or lost profits resulting from this publication or its contents. Local regulations affect product availability. Therefore, the products discussed on this publication may not be for sale of promotion in all countries. Views and Opinions expressed in this publication are independent views of the writers/commentators and are not necessarily those of the magazine and accordingly no liability is imputable to KCI Medical. Please note that the views and opinions stated in this publication are NOT medical advise.