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The management of contaminated wounds and pressure sores is frustrating, time consuming and costly. An open non healing wound can be painful, is always at risk for infective episodes and should be closed quickly. 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 7
Figure 1 A 87 year old male was found laying on his side and developed a large trochanteric pressure sore measuring 12.1 cm by 12.3 cm. He was admitted to the hospital in a semi comatose state. Figure 2 Appearance after debridement. A thin rim of fibro-cutaneous tissue is removed by sharp dissection and the edges of the wound are undermined at a deep supra fascial level about 2 to 3 cm.
Figure 3 Prior to application of Proxiderms, #2/0 nylon sutures were placed through red rubber ``booties" and tied 1-2 cm from the wound margins at 2 cm intervals to advance the the wound margins. The wound is lightly packed with dressings impregnated with anti-microbial medication of the physicians choice. Figure 4 The physician used Proxiderm model PS 460. When multiple devices are used, the spacing between the Proxiderms is approx. 2 cm. 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.
Figure 5 Appearance at nine days post surgery. Figure 6 There was one application of Proxiderms for 3 days, followed by 3 days of irrigation and
wound cleansing, 2 days of Proxiderm tissue expansion, 6 days of irrigation and wound cleansing and one day of Proxiderm tissue expansion. The wound was closed by suture on day 16 Photo appearance at 18 days post closure.
Case Report 8
Figure 1 A 90 year old patient a fractured hip developed a trochanteric pressure sore of 7 months duration measuring 6.5 by 6.1 cm. Local anesthesia was used due to the patients age and general condition. Figure 2 The wound was debrided, a thin rim of this fibro-cutaneous tissue is removed by sharp dissection and the edges of the wound are undermined at a deep supra fascial level about 2 to 3 cm. Prior to application of Proxiderms, #2/0 nylon sutures were placed and tied 1-2 cm from the wound margins. The defect is lightly packed with dressings impregnated with anti-microbial medication of the physicians choice and Proxiderm model D 460 are applied by the physician. When multiple devices are used, the spacing between the Proxiderms is approx. 2 cm Figure 3 After three applications of Proxiderms over 9 days the wound was closed by suture. Patient deceased 12 months later with no recurrence of pressure sore.
Case Report 9
Figure 1 A 66 year old resident in a nursing home with dementia, Parkinson's and multiple other problems and a trochanteric pressure sore with bone exposed. Figure 2 Prior to application of Proxiderms, sutures were placed through red rubber ``booties" and tied 1-2 cm from the wound margins at 2 cm intervals to advance the wound margins. The wound is lightly packed with dressings impregnated with anti-microbial medication of the physicians choice. Figure 3 Proxiderm models PS 460 were applied at the nursing home for 3 days prior to surgery. When multiple Proxiderms are used the spacing between Proxiderms is approximately 2 cm. 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.
Figure 4 The patient was admitted to the ambulatory surgery center, where the wound was debrided and the edges of the wound undermined about 2 to 3 cm. at a deep supra fascial level. The tissue flaps were then advanced by #2/0 nylon sutures placed and tied 1-2 cm from the wound margins decreasing the size of the wound to 2.3 cm by 6.2 cm. Proxiderm models PS 460 and D 460 were applied to close the remaining defect. After 2 days of Proxiderm expansion, followed by 4 days of irrigation and wound cleansing the wound was closed primarily by suture on day 11. There was additional one day application of Proxiderms to allow the suture line to heal in a tension free environment. Figure 5 Appearance at 17 weeks. |
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