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The placement of tissue hooks of the Proxiderm are critical
to prevent tissue hook tear through
- Tissue hooks should not be placed in edematous or inflamed tissue
- Tissue hooks must be placed a minimum of 10mm from wound margins
- Tissue hooks must anchored as deep as possible into sub cutaneous tissue
- Evaluate wound at 2-3 day intervals. In patients with fragile skin , evaluate the wound daily.
Pain management
In general, like intravenous infusions, the tissue hook insertion is uncomfortable, but thereafter discomfort is
minimal. However, in nervous patients, local anesthesia may be required, perhaps supplemented by a longer acting anesthetic agent. Thereafter oral medications of different strengths can be employed.
Dorsal Foot Lesions
The use of the Proxiderm for dorsal lesions of the foot is a judgment call for the physician. The negatives is that
the tissue hooks of the Proxiderm can ensnare tendons, especially in a thin foot. In a foot that is somewhat obese with sufficient subcutaneous tissue the Proxiderms have been used successfully
The Proxiderm is contra indicated for ischemic ulcers In the presence of
inflammatory changes (as evidenced by erythema, edema or increased heat) or of a persistent discharge, the cause must be ascertained and treated prior to application of Proxiderms. If these conditions occur during the Proxiderm procedure, the application of the devices is delayed until the condition has subsided. After the inflammation or discharge has been effectively controlled the Proxiderms may be applied.
Non-weight bearing is essential during the Proxiderm procedure for wounds on the sole of the foot. Earlier weight bearing can be destructive. Undermining, when required, is at the supra-facial or deep subcutaneous level approximately
5 -10 mm. from the margins
Wound is evaluated on intervals of 2 to 3 days. Significantly contaminated wounds are evaluated daily Sutures are not used to close small wounds under 2 cm prior to tissue expansion.
These wounds are closed by Proxiderm application only. Once the wound margins are together without tension the wound can be sutured. Upon apposition of the wound margins it is recommended that the Proxiderms be applied for an additional 2-3 days to allow to wound edges
to form a strong resilient bond in a tension free environment. Premature removal of the Proxiderms can result in regression of the wound closure
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