The Proxiderm can simplify a difficult procedure such as wounds over 3.5 cm in width and allows simultaneous closure of bi compartmental fasciotomies.   It avoids general anesthesia with its associated complications, is less traumatic and results in a quicker recovery.

Case Report 6

Figure 1 Figure 2

Figure 1   A 65 year old severe diabetic had bypass surgery approximately 3 years ago and was admitted with severe abdominal pain.   The patient had an aneurysm of the iliac area which was repaired with a by-pass graft.   One day post-operative there was swelling, loss of sensation and pulsations of the right leg, the patient developed compartment syndromes.    Medial and lateral fasciotomies were done to alleviate the pressure.    The medial wound measured 28.3 cm by 6.4 cm.  The lateral wound measured 27.2 cm by 4.9 cm.

Figure 2   The Proxiderm permits closure of both wounds simultaneously.   Prior to application of Proxiderms, the wound margins are approximated by #2/0 nylon sutures placed through red rubber ``booties" to diminish pressure of the skin and tied 1-2 cm from the wound margins at 2 cm intervals and the wound is lightly packed with dressings impregnated with anti-microbial medication of the physicians choice. 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 wrapped with dry gauze and/or Elastoplast dressing secured to the patient by adhesive tape. Appearance at 2 days of expansion.  

Figure 3

Figure 3 The physician used Proxiderm models D 460 and PS 460. 

Figure 4 Figure 5

Figure 4   Lateral fasciotomy.  There were three, two day applications of Proxiderms and the wound was closed by suture on day 6.   Proxiderms were applied to suture line where the tension was the greatest for an additional two days.   Appearance at 40 days.

Figure 5   Medial fasciotomy. There was one, two day applications of Proxiderms and the wound was closed by suture on day 2.   Proxiderms were applied to suture line where the tension was the greatest for an additional two days.   Appearance at 40 days.

Case Report 7

Figure 1

Figure 1   A 58 year old patient with vessel obstruction required a thrombectomy and ended up with a fasciotomy measuring 37.5 cm by 4.6 cm.

Figure 2 Figure 3

Figure 2   Prior to application of the Proxiderms, wound margins were undermined at a supra fascial level and advanced by #2/0 nylon sutures placed through red rubber ``booties" and tied 1-2 cm from the wound margins at 2 cm intervals.   This was able to decrease the defect by 50%.  The wound is lightly packed with dressings impregnated with anti-microbial medication of the physicians choice.   Proxiderm models D 460 were applied with a spacing of 2 cm apart to close the remaining defect.    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 wrapped with dry gauze and/or Elastoplast dressing secured to the patient by adhesive tape.

Figure 3     After 4 daily applications of Proxiderms and the wound was closed by suture on day 4.   Appearance 2 months.

Case Report 8

Figure 1

Figure 1     A  73 year old insulin dependent diabetic with decreased vascularity and severe cellulitis of the left foot which  required a fasciotomy of lateral aspect of the left foot measuring 9.1 cm by 4.0 cm.  Due to the vascularity it was felt a graft will not hold up in this area.

Figure 2 Figure 3

Figure 2   Wound margins were undermined, #2/0 nylon sutures placed through red rubber ``booties" to diminish pressure of the skin and tied 1-2 cm from the wound margins at 2 cm intervals.   After advancement of the tissue flaps the wound was pretty much together but under extreme tension and Proxiderm models D460 were applied to absorb the tension and allow the wound to heal in a tension free environment. 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 wrapped with dry gauze and/or Elastoplast dressing  secured to the patient by adhesive tape   

Figure 3   There was one three day application of Proxiderms.   Appearance at 4 months.

Case Report 9

Figure 1 Figure 2

Figure 1   A 34 year old patient was admitted with a traumatic crush wound with tibia exposed.      Appearance 4 days post debridement.      Proxiderms models D 460 and PS 460 were applied 1 to 2 cm from the wound margins and spaced 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 wrapped with dry gauze and secured to the patient by adhesive tape.  The wound was evaluated on intervals of 2 to 3 days and Proxiderms replaced as required After three intermittent applications of Proxiderms over 13 days, the patient was discharged.

Figure 2   Appearance at 23 days.

Case Report 10

Figure 1 Figure 2 Figure 3

Figure 1 A 71 year old patient underwent by-pass surgery.   Pressure necrosis of the skin necessitated a fasciotomy on the lateral and medial side of left leg and also on thigh of the left leg.  The lateral wound measured 5.1 cm by 20.5 cm, the medial wound measured    3 cm by 18.6 cm and the thigh wound measured 7.3 cm by 23.3 cm.

Figure 2   This was an extremely difficult case because of the patients vascular problems.  Prior to application of Proxiderms, wound margins of the three wounds were undermined at a deep subcutaneous level and the tissue flaps were advanced by #2/0 nylon sutures placed and tied 1-2 cm from the wound margins at 2 cm intervals.   The wound on the medial aspect of the leg was closed by these sutures, the skin was extremely tight and it was decided to apply the Proxiderms to hold tension off the suture line.

The wounds on the lateral aspect of the leg the leg and the thigh were not able to be closed by the tissue flaps and the Proxiderms was used to close the remaining defects. Prior to application of Proxiderms, the defects were lightly packed with dressings impregnated with anti-microbial medication of the physicians choice. The physician used Proxiderm model D460 which were placed 2 cm apart.

Figure 3   There were 3 daily applications of Proxiderms over 3 days and the lateral wound on the leg was closed by suture on day 3.   There were 4 daily applications of Proxiderms and the wound on the thigh was closed by suture on day 4.    Appearance at one year.

Additional Cases

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