Surgical Soft Tissue Closure of Severe Diabetic Foot Infections: A Combination of Biologics, Negative Pressure Wound Therapy, and Skin Grafting

2012 ◽  
Vol 29 (1) ◽  
pp. 143-146 ◽  
Author(s):  
Crystal L. Ramanujam ◽  
Thomas Zgonis
Keyword(s):  
Soft Tissue ◽  
Negative Pressure ◽  
Diabetic Foot ◽  
Negative Pressure Wound Therapy ◽  
Skin Grafting ◽  
Wound Therapy ◽  
Diabetic Foot Infections

scholarly journals Home based negative pressure wound therapy and moist dressing in the treatment of diabetic foot ulcers

2019 ◽  
Vol 6 (12) ◽  
pp. 4303
Author(s):  
Shiraz Basheer ◽  
Naseef Kannanavil ◽  
Sunil Rajendran
Keyword(s):  
Negative Pressure ◽  
Diabetic Foot ◽  
Negative Pressure Wound Therapy ◽  
Skin Grafting ◽  
Foot Ulcers ◽  
Diabetic Foot Ulcers ◽  
Wound Therapy ◽  
Diabetic Ulcer ◽  
Home Based ◽  
Split Skin Grafting

Background: Negative pressure wound therapy (NPWT) is a non-invasive wound closure system that uses controlled, localized negative pressure to help heal chronic and acute wounds. The objective of the present study was to compare home based NPWT and moist wound dressing in home care setting with respect to wound healing and time taken for healing among diabetic ulcer patients and the comparison of cost involved for the treatment.Methods: A hospital based prospective observational study where all patients were presented to the Department of Surgery at MES Medical College with diabetic ulcer between 1st January 2016 and 30th March 2017 were included in the study; ulcer size and surface area were measured using vernier calipers and Wagner’s grade between the two groups were evaluated at the time of enrollment.Results: Complete ulcer healing by primary intention was achieved in 86.8% in home based NPWT group vs. 44.3% in conventional moist dressing group. Average duration taken for healing in home based NPWT patient was 3.03 months and in moist dressing group was 4.58 months. Split skin grafting was needed in 2 patients in HB-NPWT group vs. 7 in moist dressing group. 9.3 hospital visits in HB-NPWT group vs 136.8 sessions in moist dressing group.Conclusions: The present study states that NPWT is superior to conventional moist dressing for the management of chronic diabetic foot ulcers. Cost is approximately 1/10th of standard NPWT.

scholarly journals A review of the TOPHAT (Turned-down Onto Pericapsular-tissue Hemisectioned Amputated Toe) filleted toe flap technique for wound coverage during ray amputations

2020 ◽  
Author(s):  
Nadia Sim ◽  
Shaun Lee ◽  
Hao Yun Yap ◽  
Qian Ying Tan ◽  
Jerilyn Tan ◽  
...  
Keyword(s):  
Wound Healing ◽  
Soft Tissue ◽  
Negative Pressure ◽  
Negative Pressure Wound Therapy ◽  
Skin Grafting ◽  
Wound Therapy ◽  
Flap Technique ◽  
The Mean ◽  
Mean Time ◽  
Ray Amputation

Abstract Background: Wound healing post ray amputation for toe gangrene is commonly complicated by adjacent digital loss after applying Topical Negative Pressure Wound Therapy (TNPWT). This is either due to mechanical soft tissue erosion or trauma to the adjacent digital artery from direct pressure effect. This ultimately results in exposure of the adjacent Metatarsal-Phalangeal Joint (MTPJ) with eventual gangrene and a larger wound bed, thus mandating further ray amputation and subsequently enlarge the wound bed. We describe the use of the TOPHAT filleted toe flap technique – a combination of a filleted toe flap to protect the adjacent MTPJ capsule and a novel Negative Pressure Wound Therapy with instillation and dwell-time (NPWTi-d) dressing technique. The fillet flap protects the adjacent joint capsule and reduce the wound burden whilst allowing the wound to benefit from TNPWT, thereby accelerating wound healing. Methods: We conducted a prospective review of patients with toe gangrene requiring ray amputations who underwent the TOPHAT filleted toe flap technique in our institution from 2019 and 2020. Complications such as wound dehiscence, hematoma, flap necrosis and secondary infection were recorded. Other outcomes recorded were time taken to final skin grafting and time taken for complete wound epithelialisation. Results: 9 patients underwent treatment with the TOPHAT filleted toe flap technique between 2019 and 2020. 2 patients had minimal tip necrosis of the flap which required minor debridement. All except 2 patients whom declined further treatment, progressed to definitive skin coverage with skin grafting. One patient had progressive arterial disease despite successful skin grafting and required above knee amputation. The mean time to final skin grafting was 49.5 days post-operatively and the mean time to final wound epithelialisation was 107.5 days post-operatively. Patients were all satisfied with the outcomes and were able to return to pre-morbid function. Conclusions: The TOPHAT filleted toe flap technique has a consistent vascular supply that provides durable soft tissue coverage. It is a robust and easily reproducible technique to accelerate wound healing after ray amputations even in patients with peripheral vascular disease.

Cost-efficacy of skin grafting techniques using negative pressure wound therapy and tissue-engineered skin for burns

2021 ◽  
Author(s):  
Muhammad Hanif Nadhif ◽  
Muhammad Satrio Utomo ◽  
Muhammad Farel Ferian ◽  
Farhan H. Taufikulhakim ◽  
Nadine H. P. Soerojo ◽  
...  
Keyword(s):  
Negative Pressure ◽  
Negative Pressure Wound Therapy ◽  
Skin Grafting ◽  
Wound Therapy ◽  
Cost Efficacy
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