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  4

Figure 1 Figure 2

Figure 1   A 34 year paraplegic patient with a ischial pressure sore, bone exposed and a wound draining contaminated by psuedomonas. 

Figure 2   The wound measured 11.9 cm by 10.9 cm after debridement.

Figure 3 Figure 4

Figure 3     Prior to application of Proxiderms, wound margins are undermined at a deep fascial level and advanced by  #2/0 nylon sutures placed at 2 cm intervals and tied 1-2 cm from the wound margins to approximate the wound margins.  The wound is lightly packed with dressings impregnated with anti-microbial medication of the physicians choice and Proxiderm model PS 460s are applied 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 

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

Figure 5

Figure 5   There were four days of Proxiderm skin expansion followed by three days of dressing changes, one day of Proxiderm skin expansion and one day of dressing changes. On the 10th day the physician was able to close the wound by suture except for an area measuring 1.1 cm by .4 cm.  Proxiderms were applied to this area.   Four days later there was final closure of the wound by suture.  Three days later the patient was discharged to a nursing home.  Photo, appearance at 6 days post closure.   Patient deceased one year later, no recurrence of pressure sore.  

Case Report  5

Figure 1 Figure 2 Figure 3

Figure 1     A 62 year old paraplegic insensate patient with a ischial pressure sore measuring 5.3 cm by 10.9 cm and a sacral pressure sore measuring 9.4 cm by 10.5 cm.  The wounds are closed sequentially.  The ischial  pressure sore is closed first. 

Figure 2   Ischial pressure sore.   Prior to application of Proxiderms the wound is debrided, undermined, cleansed and irrigated.  At 2 cm intervals,  #2/0 nylon sutures are placed and tied 1-2 cm from the wound margins to approximate the wound margins.  The wound is lightly packed with dressings impregnated with anti-microbial medication of the physicians choice and Proxiderm model D 460 and PS 460s are applied 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.

Figure 3   There were 3 daily dressing changes, irrigation, cleansing and applications of Proxiderms, the ischial pressure sore was closed by suture on day 3.   Appearance 4 days post closure.

Figure 4 Figure 5 Figure 6

Figure 4   On the fifth post closure day of the ischial pressure sore, the sacral pressure sore was debrided, undermined, cleansed and irrigated.   The wound is lightly packed with dressings impregnated with anti-microbial medication of the physicians choice.   At 2 cm intervals, #2/0 nylon sutures are placed through red rubber ``booties" to diminish pressure on the skin and tied 1-2 cm from the wound margins to approximate the wound margins.  The ends of the tied sutures are left long and will be looped around the Proxiderms to secure them to the patient.

Figure 5   The physician used Proxiderm model PS 460 which are placed 2 cm apart.  

Figure 6     There were 5 days of daily Proxiderm applications, dressing changes, irrigation, and wound cleansing, followed by 9 days of irrigation and wound cleansing. Sacral pressure sore was closed by suture on day 14 except for a small open area  (1 cm by 2 cm)

Figure 7 Figure 8

Figure 7     Six days later Proxiderms were applied for an additional 2 days and entire  wound was closed.   

Figure 8   Appearance at 45 days.

Appearence at 16 months No Recurrence

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