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 8

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Figure 1   A 41 year old patient admitted with regional ileitis had a surgical procedure for an intestinal obstruction.  Previously this area had received radiation.   Two days post op the wound became infected and the abdomen dehisced leaving a defect measuring 13.7 by 19.6 cm.  A colostomy bag on right side and fistula on left side complicated the situation.  Appearance after cleansing and debridement.   Initially the wound was not undermined since it had been extensively infected.  The wound margins are sutured to approximate the defect and lightly packed with dressings impregnated with anti-microbial medication of the physicians choice.   Five Proxiderm model PS 460 are placed 1-2 cm apart.  Four by four dressings and combines are placed beneath the ends, between and over the Proxiderms to assist in stabilization and minimize external pressure.  The Proxiderms and padding are secured to the patient by Elastoplast and/or adhesive tape.  There were 3 daily applications of Proxiderms, followed by 2 days of extensive irrigation and wound cleansing.

Figure 2   On the 5th post op day the wound margins were undermined and the tissue  flaps were advanced by #2/0 nylon sutures placed through red rubber "booties" and tied 1-2 cm from the wound margins at 2 cm intervals to approximate the wound.  The wound is lightly packed with dressings impregnated with anti-microbial medication of the physicians choice and there were another 3 daily applications of Proxiderms PS 460 and D460.

Figure 3 Figure 4

Figure 3     On the 8th post-operative day the wound is nearly approximated and final reconstruction of the wound is carried out and the wound is closed by suture. Proxiderms are applied for an additional two days to take any tension off the suture line.   

Figure 4   There were a total of eight days of Proxiderm expansion.  Appearance on 15th post op day shows a well healed wound.

Case Report 9

Figure 1

Figure 1   A 76 year old patient had an abdominal surgical procedure for a bowel carcinoma. After closure the suture line dehisced leaving a wound measuring 5.1 cm by 13.8 cm. 

Figure 2 Figure 3 Figure 4

Figure 2   Prior to application, wound margins were undermined 2 to 3 cm at a deep fascial level and #2/0 nylon sutures were placed and tied 1-2 cm from the wound margins at 2 cm intervals to approximate the wound. The wound is lightly packed with dressings impregnated with anti-microbial medication of the physicians choice. Proxiderm models (PS 460) are selected. When multiple devices are used, the spacing between the Proxiderms is approx. 2 cm

Figure 3 Four by four dressings and combines are placed beneath the ends, between and over the Proxiderms to assist in stabilization and minimize external pressure.

Figure 4 The Proxiderms and padding are secured to the patient by Elastoplast and/or adhesive tape

Figure 5

Figure 5   Wound closed by suture on day 7 after three, two day applications of Proxiderms. Appearance at 75 days shows a well healed wound.

Case Report 10

Figure 1 Figure 2

Figure 1   A 51 year old with a perforated sigmoid colon required surgery to remove a portion of colon resulting in a colostomy bag on the left side and a fistula on the right side. Wound closure became septic and dehisced. Necrotic tissue was removed by careful wound cleansing and sharp debridement resulting in an open wound measuring 19.5 cm by 7.6 cm.

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

Figure 3 Figure 4

Figure 3   The wound was sutured closed on day 3, after two applications of Proxiderms over three days. There were an additional 2 applications of Proxiderms post closure over 3 days to allow the suture line to heal in a tension free environment.

Figure 4   Appearance at 35 days.

Case Report 11

Figure 1 Figure 2 Figure 3

Figure 1   A  42 year old patient admitted for partial removal of the colon.  Following colectomy, the suture line became septic and dehisced resulting in a wound measuring  4.5 cm by 10.3 cm after debridement. Appearance 21 days after surgery.

Figure 2   Proxiderm models D 460 were applied intermittently for 10 days.   The wound was evaluated on intervals of 2 to 3 days.  

Figure 3   Appearance at 10 days.

Case Report 12

Figure 1 Figure 2

Figure 1   A 57 year old diabetic patient required surgery for a small bowel obstruction secondary to adhesions.  The wound became infected and dehisced. Attempts to close the wound twice over three months but failed and the patient was referred for closure by Proxiderm.   Appearance three months after surgery.  Wound measured 10.2 cm by 4.8 cm

Figure 2   Prior to application of Proxiderms, wound margins are undermined and #2/0 nylon sutures were placed and tied 1 to 2 cm from the wound margins at 2 cm intervals to approximate the wound. The wound is lightly packed with dressings impregnated with anti-microbial medication of the physicians choice.    Proxiderm models D 460 are selected. When multiple devices are used,  the spacing between the Proxiderms is approx. 2 cm

Figure 3 Figure 4

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   Appearance at 4 months

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