271 Treatment of thrombophlebitic necrotic lesions in a patient with syncardia—a case report

Aims The 58 years old male patient with an important dilated cardiomyopathy, carrier of ICD, numerous malignant arrhythmias (VT) and without the possibility of a timely heart transplant, underwent emergency surgery by implanting a total artificial heart syncardia. Necrotic tissue was already present on the forearm and in the antecubital region before the surgery; it was caused by extravasation and thrombophlebitis due to continuous intravenous therapies and the lesions were deep down to tendons and bones after a surgical toilet. Years of unstable haemodynamics caused by dilated cardiomyopathy and low cardiac output led to poor peripheral vascularization giving priority to noble structures. Restoration of the tissue using advanced dressings without the use of skin grafts avoiding bacterial infections in a fragile patient. Methods and results A Pubmed search for advanced dressings was performed and a Webinar on the Wound Hygiene technique was attended. In the first instance, a polyurethane foam dressing was used and the wound on the forearm showed major improvements, subsequently with the synergistic help of the ‘Wound Hygiene’ technique and dressings based on connectivine, the tissue healed. The wound located in the antecubital region had continuous biofilm formation and a VacTherapy was planned for this. After 7 days, the conditions worsened and for this reason it was decided to use the Aqua Cell Ag +. This dressing with the silver helps in the formation of granulation tissue and it also prevents infections ‘trapping’ bacteria inside it. Conclusions The use of dressings with the Wound Hygiene technique led to the formation of new tissue without the need to perform a skin graft in a patient with a total artificial heart and without bacterial infections.