Wound Care: Lower Extremity Ulcers, Family

2020 ◽  
Keyword(s):  
Lower Extremity ◽  
Wound Care

Third-Party Reimbursement for Lower-Extremity Wound Care

2002 ◽  
Vol 92 (1) ◽  
pp. 54-58
Author(s):  
Harry Goldsmith ◽  
Matthew G. Garoufalis
Keyword(s):  
Lower Extremity ◽  
Wound Care ◽  
Standard Of Care ◽  
Third Party ◽  
Foot And Ankle ◽  
Lower Extremity Wound ◽  
Third Party Reimbursement

This article describes the treatment of lower-extremity wounds, specifically foot and ankle ulcerations, in the context of reimbursement for treatments rendered. Therefore, such issues as standard of care, documentation, classification of foot wounds, coding, and reimbursement are discussed. (J Am Podiatr Med Assoc 92(1): 54-58, 2002)

scholarly journals Clinical efficacy of Thumari gel in the management of superficial non healing leg ulcers- A rare case report.

2017 ◽  
Vol 1 (1) ◽  
pp. 1-5
Author(s):  
Naresh Kumar Ghodela ◽  
Tukaram Dudhamal
Keyword(s):  
Lower Extremity ◽  
Venous Insufficiency ◽  
Treatment Approach ◽  
Wound Care ◽  
Multidisciplinary Treatment ◽  
Local Application ◽  
Rare Case Report ◽  
Arterial Insufficiency ◽  
Underlying Pathophysiology

Ulcers in lower extremity are generally caused by venous insufficiency, arterial insufficiency, and diabetic neuropathy. Inflammatory ulcers are also difficult to diagnose because of underlying pathophysiology rests on inflammation and immunologic phenomena. Definitive diagnosis and multidisciplinary treatment approach are needed to manage lower extremity ulcers. These ulcers may hamper the quality of life of patient. Here we reported a new case of post fracture of shaft of right tibia bone, presented with painful, hypertrophied, irregular shaped ulcer on anterior aspect of tibia gradually developing since 3 months. A male patient of 45 years old consulted to OPD with above complaint that was unable to bear weight on the effected leg (right limb). This case was managed with a local application of Thumari Gel and ulcers were almost healed within 6 weeks of wound care along with internal use of Ayurveda medicines. This case concluded that regular local application of Thumari Gel helpful in healing of chronic ulcer.

scholarly journals Damage control hip disarticulation: two-stage operation with index creation of a large medial flap for the septic hip

2020 ◽  
Vol 5 (1) ◽  
pp. e000502
Author(s):  
Christina Colosimo ◽  
Charles Fredericks ◽  
James R Yon ◽  
John C Kubasiak ◽  
Faran Bokhari ◽  
...  
Keyword(s):  
Lower Extremity ◽  
Hospital Discharge ◽  
High Mortality ◽  
Wound Care ◽  
Damage Control ◽  
Mortality Rates ◽  
Consecutive Series ◽  
Postoperative Wound ◽  
Hindquarter Amputation

BackgroundAlthough rarely performed, hip disarticulation (HD) is usually used for the patient with a non-viable leg who is also in extremis. HD was first used for trauma and infection; however, the technique was perfected during the age of hindquarter amputation for osteosarcomas. The operation performed by most surgeons today is still based on the oncological principles of high vessel control and ligation. When this approach has been used in the overwhelmingly infected or mangled extremity, it has resulted in high mortality rates. During the last 20 years, the concept of damage control operation has been embraced by emergency surgeons in all fields. We sought to extrapolate this concept and to apply it to the non-viable lower extremity.MethodsWe describe a new concept of damage control HD, review the technique and discuss our consecutive series of nine patients who underwent the procedure for trauma or necrotizing infection without flap dehiscence or mortality.ResultsAll patients survived to hospital discharge. At time of discharge or at follow-up, six of the nine patients were able to transfer to a wheelchair.DiscussionProper disarticulations for infection need to address these two operative and postoperative issues: damage control debridement with creation of sufficient flap size and thorough postoperative wound care.Level IV

External Thermoregulation of Wounds Associated with Lower-Extremity Osteomyelitis

2003 ◽  
Vol 93 (1) ◽  
pp. 18-22 ◽  
Author(s):  
Jeffrey C. Karr
Keyword(s):  
Pilot Study ◽  
Lower Extremity ◽  
Ulcer Healing ◽  
Wound Closure ◽  
Wound Care ◽  
Surgical Excision ◽  
Wound Therapy ◽  
Healing Of Wounds ◽  
New Treatment ◽  
Case Presentations

External thermoregulation using noncontact normothermic wound therapy accelerates wound closure by second intention in areas of existing osteomyelitis before surgical excision compared with standard wound care. This pilot study consisted of two arms. The control arm received standard wound care, which resulted in complete ulcer healing at an average of 127 days. The treatment arm received noncontact normothermic wound therapy, which resulted in complete ulcer healing at an average of 59 days, or 54% faster than in the control arm. This new treatment allows the physician to decrease the rate of limb loss and recurrent osteomyelitis by decreasing the morbidity of bone reinfection through the wound bed. There have been no published studies or case presentations addressing thermoregulation in the management of wounds associated with osteomyelitis. Although noncontact normothermic wound therapy is not a direct treatment for osteomyelitis, this new treatment option results in significantly accelerated healing of wounds associated with osteomyelitis. (J Am Podiatr Med Assoc 93(1): 18-22, 2003)

Timing of Free Flaps for Traumatic Wounds of the Lower Extremity: Have Advances in Perioperative Care Changed the Treatment Algorithm?

2019 ◽  
Vol 35 (08) ◽  
pp. 616-621 ◽  
Author(s):  
Charles W. Patterson ◽  
Mark W. Stalder ◽  
William Richardson ◽  
Thomas Steele ◽  
M. Whitten Wise ◽  
...  
Keyword(s):  
Logistic Regression ◽  
Lower Extremity ◽  
Perioperative Care ◽  
Wound Care ◽  
Treatment Algorithm ◽  
Adverse Outcomes ◽  
Recipient Site ◽  
Independent Variables ◽  
Flap Loss ◽  
Injury Classification

Abstract Background Despite the landmark study by Godina 30 years ago, opinions still vary within the literature about the management of complex traumatic wounds in the lower extremity. We present a large series of lower extremity reconstructions with vascularized free tissue and examine the perioperative factors that influenced the success of these cases. Methods We reviewed 88 patients with free flap reconstruction of traumatic lower extremity wounds over 8 years. Primary outcomes were flap infections, flap loss, total flap-specific complications, and total recipient site complications. Independent variables specific to perioperative care including time to flap coverage, injury classification, exposed or infected hardware, prior osteomyelitis, use of wound vacuum-assisted closure (VAC) therapy, and concurrent polytrauma were investigated to establish their influence on primary outcomes. Each independent variable was assessed using Chi-square or Fisher's exact test and was included in a logistic regression analysis to establish significance. Results Of the 88 patients, 8 had flap loss, 8 had flap infections, and a total of 23 had primary adverse outcomes. Timing of the reconstruction, VAC use, injury classification, prior hardware or wound status, or presence of polytrauma had no statistically significant impact on the primary outcomes. Injury classification/severity on total recipient site complications (p = 0.051) and flap-specific complications (p = 0.073) trended toward significance; however, subgroup analysis did not achieve significance. Logistic regression of any recipient site complication including all independent variables similarly showed no significance. Conclusion Although the original study by Godina suggests early coverage is critical to optimize outcomes, in the modern era of advanced wound care, our study adds to a growing body of evidence that supports the de-emphasis of the 72-hour reconstruction interval. Our current management is focused on more effectively coordinating efficient peritraumatic and perioperative care on an individualized basis in the often very complicated polytrauma patient.

scholarly journals Pyoderma gangrenosum–like ulceration of the lower extremity secondary to sunitinib therapy: a case report

2018 ◽  
Vol 6 ◽  
pp. 2050313X1878304 ◽  
Author(s):  
Mildred Lopez Pineiro ◽  
Eric Willis ◽  
Chen Yao ◽  
Susan Y Chon
Keyword(s):  
Squamous Cell Carcinoma ◽  
Lower Extremity ◽  
Cell Carcinoma ◽  
Pyoderma Gangrenosum ◽  
Squamous Cell ◽  
Kinase Inhibitor ◽  
Wound Care ◽  
Diagnostic Challenge ◽  
Recurrent Squamous Cell Carcinoma ◽  
Grade 3

Sunitinib is a multi-targeted receptor tyrosine kinase inhibitor used for the treatment of multiple different types of malignancies. Serious grade 3–4 adverse events occur in <10% of the patient population and usually improve with dose reduction. One of the more rarely reported side effects of sunitinib therapy is the development of pyoderma gangrenosum–like ulcerations in the lower extremities. These pyoderma gangrenosum–like ulcerations are difficult to treat and distinguish from similar-appearing dermatological diagnoses. We present a patient with refractory lung carcinoma and a past medical history of squamous cell carcinoma of the lower extremity, who developed a non-healing ulceration at the previous site of her skin cancer while undergoing therapy with sunitinib. At the time of the initial evaluation, the ulceration mimicked recurrent squamous cell carcinoma, posing a diagnostic challenge. Histopathological findings showed epidermal hyperplasia, ulceration, and dense acute inflammation. Despite meticulous wound care and treatment of infection, the ulcer only improved with cessation of sunitinib.

Hyperbaric oxygen therapy for severe blast injury of lower extremity after terrorist attack: case report

2019 ◽  
pp. 75-79
Author(s):  
Bengusu Mirasoglu ◽  
Engin Egeren ◽  
Huseyin Karakaya ◽  
Samil Aktas ◽  
Keyword(s):  
Lower Extremity ◽  
Hyperbaric Oxygen ◽  
Ischemia Reperfusion Injury ◽  
Wound Care ◽  
Terrorist Attack ◽  
Ischemia Reperfusion ◽  
Blast Injury ◽  
Tissue Level ◽  
Reconstructive Operations ◽  
Hbo2 Therapy

More blast injuries are encountered in the civilian setting in recent years as terrorist attacks have increased globally. A 17-year-old male patient with severe blast injury of the right lower extremity was admitted to our department on the fifth day after a terrorist bombing attack. Initially he had been admitted to an emergency department with segmental tibia fracture and arterial injury (Gustilo IIIC). An amputation had been foreseen due to ischemia that persisted even after orthopedic fixation and revascularization interventions, followed by fasciotomy incisions. After consultation with our department hyperbaric oxygen (HBO2) therapy was administered twice daily for the first week. Ischemia improved prominently after 10 HBO2 sessions. HBO2 therapy was continued together with antibiotherapy and wound care. The patient underwent a total of 40 HBO2 sessions and two reconstructive operations and healed without amputation. Vascular injuries with concomitant orthopedic trauma cause most of the delayed amputations in bombing attacks since ischemia can persist at the microvascular level even though adequate treatments are applied. HBO2 corrects hypoxia at tissue level and so provides oxygen for the critically ischemic cells in the injured area. HBO2 also enhances host defense and decreases the ischemia reperfusion injury. In this case, HBO2 was effective in survival and functional recovery (salvage) of the extremity together with regular wound care, antibiotherapy and surgical repair.

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