The management of skin deficit wounds, wounds that dehisce and contaminated wounds is frustrating and time consuming.  The Proxiderm can simplify a difficult procedure, avoid general anesthesia with its associated complications, is less traumatic and results in a quicker recovery

Case Report 1

Figure 1

Figure 1   A 73 year old diabetic patient required multiple surgical procedures for gangrene of the small bowel resulting in a ileostomy and multiple fistulas. Shortly after surgery, the entire abdominal area became infected, and dehisced resulting in an abdominal wall defect measuring 29.1 cm by 23.8 cm.

Figure 2 Figure 3 Figure 4

Figure 2 The wound was closed in 2 stages. Once the superior aspect of the wound is closed by the Proxiderm procedure the physician will then close the inferior aspect of the wound. The wound margins of the superior aspect of the wound are approximated by #2/0 nylon sutures placed through rubber "booties" to diminish  pressure on the skin and tied 1-2 cm from the wound margins at 2 cm intervals.  The ends of the tied sutures are left long, later they will be looped around the Proxiderms for increased stabilization.  

Figure 3 The wound is lightly packed with dressings impregnated with an anti-microbial medication of the physicians choice and Proxiderm models PS 460 and D 460 are applied ; the spacing between the Proxiderms is approximately 2 cm.

Figure 4 After three daily applications of Proxiderms and intensive wound toilette, the superior aspect of the wound was sutured closed reducing the size of the wound to 16.5 cm by 17.9 cm

Figure 5 Figure 6 Figure 7

Figure 5 Five days later Proxiderms PS 460 were applied to the inferior aspect of the wound. Prior to application of the Proxiderms, the wound was approximated by #2/0 nylon sutures placed and tied 1-2 cm from the wound margins at 2 cm intervals.   The spacing between the Proxiderms is approximately 2 cm.

Figure 6 Three, two day applications of Proxiderms and three days of irrigation were carried out. The entire wound was closed by suture on day 18.  There was one additional two day application of Proxiderms to allow the suture line to heal in a tension free environment.

Figure 7 Appearance 21 days after closure shows a well healed wound.

Case Report 2

Figure 1

Figure 1 An 83 year old patient required surgery for the management of an ischemic, necrotic small bowel. Four days after surgery the wound dehisced leaving a defect measuring 7.2 cm by 15.5 cm.  There was a colostomy bag on the right side and a fistula on the left side. Appearance after debridement.

Figure 2 Figure 3 Figure 4

Figure 2 Prior to application of Proxiderms, the wound margins are undermined and approximated by #2/0 nylon sutures placed through red rubber "booties" to diminish pressure on the skin and tied 1-2 cm from the wound margins at 2 cm intervals.   The wound is lightly packed with dressings impregnated with anti-microbial medication of the physicians choice.

Figure 3   The physician used Proxiderm model D 460s which are placed 1-2 cm apart.

Figure 4   Four by four dressings and combines are placed beneath the ends, between and over the Proxiderms to assist in stabilization of the devices and to minimize external pressure. The Proxiderms and padding are secured to the patient by Elastoplast and/or adhesive tape.

Figure 5 Figure 6

Figure 5   The wound was closed by suture on day 10 after 4 daily applications of Proxiderms and six days of irrigation. There was an addition 2 days of Proxiderm application to allow the suture line to heal in an tension free environment. Appearance on 8th post closure day

Figure 6   Appearance at 33 days.

Case Report 3

Figure 1 Figure 2 Figure 3

Figure 1   A 78 year old diabetic on dialysis required surgery for intestinal obstruction due to necrosis of the small bowel. Albumin level was 1.9.   Five days after surgery the abdominal wall dehisced leaving a wound measuring 14.1 cm by 4.7 cm by 3.1 cm deep. Appearance after debridement.

Figure 2   Prior to application of  Proxiderms, wound margins are undermined and #2/0 nylon sutures are placed and tied 1-2 cm from the wound margins at 2 cm intervals to approximate the wound margins .  The wound is lightly packed with dressings impregnated with anti-microbial medication of the physicians choice.   The physician used Proxiderm model D 460s which are placed 1-2 cm apart. 

Figure 3   The wound was closed by suture on day 2, after 2 daily applications of Proxiderms.  The Proxiderms were applied for an additional 2 days to allow the suture line to heal in a tension free environment.

Figure 4 Figure 5

Figure 4   Patient discharged to nursing home one week after closure. Appearance 17 days post closure

Figure 5   Appearance at 38 days post closure

Additional Cases

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