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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 5
Figure 1 A 63 year old insulin dependent diabetic with a spinal abscess. Patient became insensate from the waist down and developed a necrotic, infected sacral pressure sore a few centimeters from the rectum measuring 10.0 by 11.7 cm. Figure 2 Necrotic tissue is removed by careful wound cleansing and sharp debridement. Prior to application of Proxiderms, #2/0 nylon sutures were placed and tied 1-2 cm from the wound margins at 2 cm intervals to approximate the wound margins. The wound is lightly packed with dressings impregnated with anti-microbial medication of the physicians choice. Proxiderm models (PS 460) and D 460 are selected. When multiple devices are used, the spacing between the Proxiderms is approximately 2 cm.
Figure 3 The wound was closed by suture on day eight after 4 applications of Proxiderms over 8 days. Twenty days after the patient was discharged to the nursing home, the wound opened and the patient was taken to the ambulatory surgery center where the wound was excised and the Proxiderms applied for 2 days. Appearance at 28 days. Figure 4 Eight months later the wound reopened and was sutured closed. Appearance at 18
months. No recurrence at 25 months. Case Report 6
Figure 1 A 79 year bed bound stroke patient developed a sacral pressure sore at home measuring 5.9 by 6.1 cm with bone exposed. Figure 2 The wound is debrided and cleansed Figure 3 Prior to application of Proxiderms, #2/0 nylon sutures were placed through red rubber ``booties" to diminish pressure on the skin and tied 1-2 cm from the wound margins at 2 cm intervals to approximate the wound margins. The wound is lightly packed with dressings impregnated with anti-microbial medication of the physicians choice.
Figure 4 Proxiderm models (PS 460) are selected. When multiple devices are used, the spacing between the Proxiderms is approx. 2 cm. Figure 5 There were 4 applications of Proxiderms over 12 days and the wound was closed by suture on day 12 . Appearance on 5th expansion day. Figure 6 The wound opened at 2 months was sutured and treated conservatively. Appearance at 24 months, no recurrence.
Figure 1 A 84 year old bed bound patient with vascular lung lesion, low albumin and huge sacral pressure measuring 8.7 by 15.2 cm with exposed bone. Figure 2 Prior to application of Proxiderms, #2/0 nylon sutures were placed through red rubber ``booties" to diminish pressure on the skin and tied 1-2 cm from the wound margins at 2 cm intervals to approximate the wound margins. The wound is lightly packed with dressings impregnated with anti-microbial medication of the physicians choice. The physician was able to close entire area except for central area defect of 3.5 cm by 2 cm by 1.5 cm. Proxiderm models PS 460 were applied 4 times over 5 days and the wound was sutured closed on day 5. Figure 3 Photo appearance at 17 days post closure. Patient deceased 6 months later, no recurrence. |
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