Analysis of the Therapeutic Effect of Artificial Leather Embedding Combined with Fascial Sleeve Flap Transplantation on Chronic Wounds of Lower Limbs with Bone and Plate Exposure

Abstract Background: After severe trauma of lower limbs, bone、tendon or plate graft exposure is common.The traditional repair method is to use a variety of skin flap transplantation to cover the exposed part, but the wound often can not heal after operation, or the wound is cracked, ulcer, sinus, bone and steel plate are exposed again after wound healing.The reason for this result is that when the flap is covered, the space around the bone plate is not well closed, forming a dead cavity, blood and exudate accumulation, hematoma formation or infection, and finally the wound ruptures again. In addition, due to the swelling and contracture of the flap after operation, the suture tension between the flap and the receiving area becomes larger, the skin becomes thinner and broken, and then the wound is formed. In order to solve the above problems, we carried out the study of artificial true skin embedding combined with fascial sleeve flap transplantation in the treatment of chronic bone plate exposed wounds of lower limbs.Methods: In this paper, 11 cases of chronic wounds with bone exposure and skin necrosis after steel plate implantation were selected. First stage is the wound bed preparation including primary wound expansion,removal of necrotic tissue and incision of sinus wall, removal of deep necrotic bone and fibrotic scarred skin on the outer wall of steel plate to normal tissue on the outer edge of the wound, removal of precipitated peptone and purulent fur in the hole, periphery and bone space of the steel plate, and removal of tendon tissue with basal necrosis and disintegration of the wound. After vacuum sealing drainage (VSD) 1~2 weeks, the peritraumatic basal granulation tissue grew well and there was no necrotic tissue in the wound. In the second stage, the exposed bone was covered with artificial dermis, the steel plate hole or the periphery and the basal space were filled, and the exposed steel plate was completely embedded, and then the fascia sleeve flap was transplanted to cover the wound. The sural neurovascular flap was performed in 9 cases and the lateral superior malleolar artery perforator flap in 2 case. Results: The flap survived well in all 11 cases. During the follow-up of 6 months to the removal of the plate, there was no case of rupture, exposure and sinus formation.Conclusions: Artificial dermal covering combined with fascial sleeve flap transplantation can effectively avoid wound dehiscence or sinus formation caused by foreign body retention, infection and flap contracture,It has good effect in repairing chronic wounds with bone plate exposure after severe trauma of lower limbs.

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Application of Artificial Dermal Graft Combined with Fascia Sleeve Flap in the Treatment of Chronic Bone and Steel Plate Exposed Wounds of Lower Extremities

10.21203/rs.3.rs-942317/v1 ◽

2021 ◽

Author(s):

Yong Li ◽

Zhi-bo Zhang ◽

Ji-song Liu ◽

Zhu-min Wu ◽

Xin-cheng Sun ◽

...

Keyword(s):

Chronic Wounds ◽

Steel Plate ◽

Wound Dehiscence ◽

Severe Trauma ◽

Lower Limbs ◽

Bone Plate ◽

Good Effect ◽

Necrotic Tissue ◽

Sinus Formation ◽

Neurovascular Flap

Abstract Background:Bone tendon or graft exposure such as steel plate is common after severe trauma of lower extremity.The traditional repair method is to use a variety of skin flaps to cover the exposure, but the wound can not heal after operation, or the wound dehiscence, ulcer, sinus, etc. occur again after short healing, and the bone plate is exposed again.The reason for this result is that the space around the bone plate is not well closed when the flap is covered，dead space is formed, blood and exudate accumulate, hematoma forms or infection occurs, and finally the wound breaks.Also due to swelling and contracture after flap operation,the tension of the suture between the flap and the receiving area is too large and becomes thin and cracked, forming an exposed state.In order to solve the above problems, we have carried out the research on "Application of artificial gradient combined with fascia sleep flap in the treatment of chronic bone and steel plate exposed woods of lower extremes".Methods:In this paper, 11 cases of chronic wounds with bone exposure and skin necrosis after steel plate implantation were selected. First stage is the wound bed preparation including primary wound expansion,removal of necrotic tissue and incision of sinus wall, removal of deep necrotic bone and fibrotic scarred skin on the outer wall of steel plate to normal tissue on the outer edge of the wound, removal of precipitated peptone and purulent fur in the hole, periphery and bone space of the steel plate, and removal of tendon tissue with basal necrosis and disintegration of the wound. After vacuum sealing drainage (VSD) 1~2 weeks, the peritraumatic basal granulation tissue grew well and there was no necrotic tissue in the wound. In the second stage, the exposed bone was covered with artificial dermis, the steel plate hole or the periphery and the basal space were filled, and the exposed steel plate was completely embedded, and then the fascia sleeve flap was transplanted to cover the wound. The sural neurovascular flap was performed in 6 cases and the lateral superior malleolar artery perforator flap in 1 case. Results:The flap survived well in all 11 cases. During the follow-up of 6 months to the removal of the plate, there was no case of rupture, exposure and sinus formation.Conclusions:Artificial dermal covering combined with fascial sleeve flap transplantation can effectively avoid wound dehiscence or sinus formation caused by foreign body retention, infection and flap contracture,It has good effect in repairing chronic wounds with bone plate exposure after severe trauma of lower limbs,.

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Experience of using atraumatic ointment bandages based on peruvian balsam in the complex treatment of patients with chronic wound defects of the lower limbs

Hirurg (Surgeon) ◽

10.33920/med-15-2002-05 ◽

2020 ◽

pp. 43-57

Author(s):

Anna Tabuika

Keyword(s):

Diabetes Mellitus ◽

Staphylococcus Aureus ◽

Chronic Wounds ◽

Chronic Wound ◽

Local Treatment ◽

Lower Limbs ◽

Complex Treatment ◽

Average Area ◽

Arterial Insufficiency ◽

Significant Activation

The article reflects the results of a retrospective non-comparative study, the objects of which were 34 outpatient comorbid patients (15 of which are over 60 years old) with chronic wounds of the lower limbs developed against the background of varicosity, post-thrombotic disease, chronic arterial insufficiency of the lower limbs, diabetes mellitus or their combination. Their local treatment was carried out using atraumatic ointment dressing «Branolind N» containing Peruvian balsam. There were 23 women (67.6 %) and 11 men (32.4 %). In microbiological study prior to the beginning of treatment in 31 patients the growth of a pathogen of wound infection was revealed; in 19 patients — Staphylococcus aureus in monoculture and in various associations, in 6 patients — Pseudomonas aeruginosa in monoculture, in other cases — other pathogens. In 3 patients the pathogen was not detected. The average wound size was 34 cm2 . The phase of the wound process was additionally confirmed by cytological studies. After treatment the average area of the wound defect decreased by 10 cm2 and made 24 cm2 on average. Full healing of the wound defect occurred in 11 patients, the others had granulation and active marginal epithelization. There was also a decrease in bacterial semination of wounds, a change in composition of infection agents to less aggressive monoflora, and cytologically — a decrease in signs of inflammation against the background of significant activation of reparative processes.

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Maggot Treatment of Necrotic Toe Developed After Traumatic Subtotal Amputation

The International Journal of Lower Extremity Wounds ◽

10.1177/1534734621997283 ◽

2021 ◽

pp. 153473462199728

Author(s):

Erdem Sahin ◽

Bedri Karaismailoglu ◽

Mehmed Nuri Tutuncu ◽

Erdal Polat ◽

Huseyin Botanlioglu

Keyword(s):

Chronic Wounds ◽

Necrotic Tissue ◽

Complete Necrosis ◽

Maggot Debridement Therapy

Maggot debridement therapy (MDT) has been used for years in the treatment of chronic wounds and necrotic tissues. We report a case of subtotally amputated third toe that was treated with MDT after reattachment and developing complete necrosis. The necrotic toe was replaced with viable tissue and the wound healed completely after 2 weeks of MDT application. This case points out the regenerative effects of MDT besides its mechanical debridement effect on the necrotic tissue.

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Influence of Antihypertensive and Antidiabetic Drugs on Wound Healing – Essentials of a Systematic In-Vitro Study

Dermatology and Dermatitis ◽

10.31579/2578-8949/050 ◽

2019 ◽

Vol 4 (1) ◽

pp. 01-04

Author(s):

Ewa K. Stuermer

Keyword(s):

Wound Healing ◽

Life Style ◽

Chronic Wounds ◽

In Vitro Study ◽

Antidiabetic Drugs ◽

Vitro Study ◽

Lower Limbs ◽

Nerve Lesions

Due to the increasing prevalence of so called "life style diseases", such as diabetes, obesity or hypertension, the number of associated vascular and nerve lesions increases. In the lower limbs in particular, bagatelle trauma causes wounds that lead to wound healing disorders and chronic wounds

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The Effect of Virtual Reality Distraction on Pain Relief During Dressing Changes in Children with Chronic Wounds on Lower Limbs

Pain Management Nursing ◽

10.1016/j.pmn.2015.03.001 ◽

2015 ◽

Vol 16 (5) ◽

pp. 685-691 ◽

Cited By ~ 47

Author(s):

Yun Hua ◽

Rong Qiu ◽

Wen-yan Yao ◽

Qin Zhang ◽

Xiao-li Chen

Keyword(s):

Virtual Reality ◽

Pain Relief ◽

Chronic Wounds ◽

Lower Limbs

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PRACTICES OF CHRONIC WOUNDS HOME CARE PERFORMED BY THE ELDERLY AND THEIR CAREGIVERS

Revista Eletronica Gestão & Saúde ◽

10.26512/gs.v0i0.23319 ◽

2019 ◽

pp. 162-175

Author(s):

Carolina Leite Ossege ◽

Andréa Mathes Faustino

Keyword(s):

Home Care ◽

Activities Of Daily Living ◽

Daily Living ◽

Chronic Wounds ◽

The Elderly ◽

Lower Limbs ◽

Support Network ◽

Network Profile ◽

Discharge From Hospital

Regarding the indispensable care for the treatment of chronic wounds, the dependence and the reduction of functional ability can lead to the reduction of care attitudes, just as autonomy can be a contributing factor for the quality of life of the elderly. Thus, the present study aimed to identify the practices of home care of chronic wounds performed by the elderly and their caregivers. The age of the elderly ranged from 60 to 81 years; the majority were male (60%), married (60%), with family caregiver (80%), hospitalized for oncology (40%), independent for activities of daily living (90%) and partially dependent for instrumental activities of daily living (50%). The most common chronic lesions found in the elderly were those located in the lower limbs, related to diabetes and tumors. It was concluded that the elderly presented functional capacity and family support network profile compatible with the practice of home care; however, regarding the care of chronic injuries, not all steps of care were appropriately performed, suggesting unpreparedness to deal with the adverse situation, which reinforces the need of preparation for discharge from hospital.

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Custo da terapia tópica em pacientes com lesão por pressão

Revista de Enfermagem UFPE on line ◽

10.5205/1981-8963-v12i10a237569p2555-2563-2018 ◽

2018 ◽

Vol 12 (10) ◽

pp. 2555

Author(s):

Daniel De Macêdo Rocha ◽

Sandra Maria Gonçalves Bezerra ◽

Aline Costa De Oliveira ◽

Josiane Santos Silva ◽

Italo Arão Pereira Ribeiro ◽

...

Keyword(s):

Cost Analysis ◽

Pressure Ulcer ◽

Chronic Wounds ◽

Topical Therapy ◽

Lower Limbs ◽

Cross Sectional ◽

Stage 4 ◽

The Cost ◽

The Impact ◽

Complex Wounds

RESUMOObjetivo: avaliar o custo da terapia tópica em pacientes com lesão por pressão. Método: estudo quantitativo, transversal e analítico realizado em um ambulatório de referência para tratamento de feridas complexas. A amostra constituiu-se de 20 participantes que procuraram o serviço para a avaliação e o tratamento da lesão. Utilizou-se, para a coleta de dados, um formulário para a caracterização sociodemográfica, clínica, terapêutica e de análise de custo. Realizou-se a análise por meio da estatística descritiva e inferencial. Resultados: houve o predomínio do sexo masculino, com idade média de 56,6 anos e de pacientes procedentes de Teresina. Prevaleceram feridas crônicas, localizadas na região sacral e em estágio 4. A análise do custo mostrou que as lesões em membros inferiores com odor fétido, tecido desvitalizado, exsudato intenso e que foram tratadas com o carvão ativado, espuma com prata e hidrofibra apresentaram maior custo. Conclusão: mostrou-se que a lesão por pressão apresentou alto custo determinado pelas características clínicas e métodos terapêuticos adotados. Evidenciou-se a necessidade da implementação de medidas preventivas e de novos estudos para mostrar o impacto da lesão nos serviços de saúde. Descritores: Ferimentos e Lesões; Lesão por Pressão; Bandagem; Custo e Análise de Custos; Enfermagem; Cuidados de Enfermagem.ABSTRACT Objective: to evaluate the cost of topical therapy in patients with pressure ulcers. Method: quantitative, cross-sectional and analytical study carried out at a reference outpatient clinic for the treatment of complex wounds. The sample consisted of 20 participants who sought the service for evaluation and the treatment of the ulcer. A form for sociodemographic, clinical, therapeutic and cost analysis was used for data collection. The analysis was carried out through descriptive and inferential statistics. Results: there was a predominance of males, with a mean age of 56.6 years and of patients coming from Teresina. Chronic wounds prevailed, located in the sacral region and in stage 4. The cost analysis showed that lesions in the lower limbs, with fetid odor, devitalized tissue, intense exudate and that were treated with activated charcoal, silver foam and hydrofiber presented higher cost. Conclusion: it was shown that the pressure ulcer presented a high cost determined by the clinical characteristics and therapeutic methods adopted. The need to implement preventive measures and new studies to show the impact of the injury on health services was evidenced. Descriptors: Wounds and Injuries; Pressure Ulcer; Bandages; Costs and Cost Analysis; Nursing; Nursing Care. RESUMEN Objetivo: evaluar el costo de la terapia tópica en pacientes con lesión por presión. Método: estudio cuantitativo, transversal y analítico realizado en un ambulatorio de referencia para el tratamiento de heridas complejas. La muestra se constituyó de 20 participantes que buscaban el servicio para la evaluación y el tratamiento de la lesión. Se utilizó, para recolección de datos, un formulario para caracterización sociodemográfica, clínica, terapéutica y análisis de costo. Se realizó el análisis por medio de la estadística descriptiva e inferencial. Resultados: hubo el predominio del sexo masculino, con una edad media de 56,6 años y de pacientes procedentes de Teresina. Prevalecían heridas crónicas, localizadas en la región sacra y en etapa 4. El análisis del costo mostró que las lesiones en miembros inferiores, con olor fétido, tejido desvitalizado, exudado intenso y que fueron tratadas con el carbón activado, espuma con plata e hidrofibra presentaron mayor costo. Conclusión: se mostró que la lesión por presión presentó alto costo, siendo determinada por las características clínicas y métodos terapéuticos adoptados. Se evidenció la necesidad de la aplicación de medidas preventivas y de nuevos estudios para mostrar el impacto de la lesión en los servicios de salud. Descriptores: Heridas y Lesiones; Úlcera por Presión; Vendajes; Costos y Análisis de Costo; Enfermería; Atención de Enfermería.

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Maggot debridement therapy for the treatment of diabetic foot ulcers: robbing the rich past to give to the sore

Journal of the Nuffield Department of Surgical Sciences ◽

10.37707/jnds.v2i2.144 ◽

2021 ◽

Vol 2 (2) ◽

Author(s):

Joseph Cutteridge ◽

Katarzyna Bera

Keyword(s):

Diabetic Foot ◽

Chronic Wounds ◽

Multiorgan Failure ◽

Foot Ulcer ◽

Diabetic Foot Ulcer ◽

Necrotic Tissue ◽

Foot Care ◽

Surgical Interventions ◽

Wound Debridement ◽

Maggot Debridement Therapy

A diabetic foot ulcer (DFU) is a serious complication of diabetes mellitus that results in significant morbidity and mortality. The lifetime risk of a patient with diabetes developing a DFU is 15-25%1. Furthermore, the incidence of DFUs is increasing in line with the growing burden of diabetes worldwide. The number of lower limb amputations secondary to diabetes has reached an all-time high in England, with 26,378 recorded from 2014-2017, an increase of 19.4% from 2010-20132. Maggot debridement therapy (MDT) involves the application of sterile larvae, usually of the species Lucilla sericata (common green bottle fly), which remove devitalised tissue to promote wound healing. This historical therapy re-emerged in the 1990s to combat the increasing incidence of recalcitrant wounds, such as DFUs. Since its reintroduction, there has been ongoing debate in the medical literature regarding the efficacy of MDT in the treatment of DFUs and other chronic wounds. We present the case of a 57-year-old male admitted with diabetic foot sepsis and multiorgan failure and discuss how MDT was used to complement initial surgical and antibiotic management. A 14-day course of MDT improved wound debridement and decreased necrotic tissue burden, after which no further surgical interventions were needed. This case provides further evidence that MDT is effective in the selective debridement of necrotic tissue and can aid the preservation of limb length in DFU patients, thereby highlighting the importance of MDT in multispecialist diabetic foot care.

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Efficacy of Negative Pressure Therapy (NPWT) in the Management of Wounds of Different Etiologies

Revista de Chimie ◽

10.37358/rc.18.8.6458 ◽

2018 ◽

Vol 69 (8) ◽

pp. 1980-1986

Author(s):

Mihaela Pertea ◽

Natalia Velenciuc ◽

Vladimir Poroch ◽

Petru Ciobanu ◽

Mihaela Boanca ◽

...

Keyword(s):

Negative Pressure ◽

Chronic Wounds ◽

Length Of Hospital Stay ◽

Soft Tissue Defect ◽

Lower Limbs ◽

Adhesive Tape ◽

Subatmospheric Pressure ◽

Pressure Therapy ◽

Application Frequency ◽

Hospital Days

The objective was to assess the role of negative pressure wound therapy (NPWT) in the management of wounds of various etiologies, infected or not, acute or chronic. The study was conducted in a group of 37 patients (24 men and 13 women) aged 26 to 86 years with acute or chronic wounds, posttraumatic or due to chronic diseases located on the lower limbs or following oncological abdominal surgery. In all cases a Vacuum Assisted Closure (VAC) system was continuously applied using a subatmospheric pressure ranging from 90 to 120 mmHg. Beside sex, age and etiology of soft tissue defect the following parameters were studied: surgical treatment performed prior to NPWT application, frequency of dressing changes, duration of NPWT, level of subatmospheric pressure used in each case, number of hospital days, complications arising from NPWT use. The outcome was favorable in all cases without such complications as infection or bleeding, a perilesional erythema (contact dermatitis caused by the used adhesive tape) being noted in only 13.51% of cases. The average duration of NPWT was 8.1 days. The frequency of dressing changes was in most cases of 3 days (89.18%) with a group mean of 3.05 days, and the average applied negative pressure was -110.83 mmHg, range -90mmHg to -120 mm Hg. No complications requiring the interruption of NPWT use were recorded. NPWT, by stimulating wound constriction and granulation tissue formation is an option in the management of acute or chronic wounds of various etiologies, whether infected or not, resulting in a decrease in the number of surgeries and their complexity, length of hospital stay and, last but not least, reduced patient suffering.

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