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Comprehensive Management of Complex Wound Injuries: A Case Study Review

This case study discusses the treatment of three complex wound cases: a 55-year-old female with dehisced sternal and leg wounds, a 39-year-old male with shoulder wound osteomyelitis, and a 51-year-old female with a necrotizing perineal cyst. Each case emphasizes the importance of multidisciplinary care in wound management, including surgical interventions, hyperbaric oxygen treatments, and advanced therapies like VAC therapy. The study showcases significant healing progress in all patients and highlights the role of collaboration among various specialties in optimizing patient outcomes.

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Comprehensive Management of Complex Wound Injuries: A Case Study Review

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  1. CASE STUDY #1 DEHISCED STERNAL MUSCLE FLAP, DEHISCED LEG, ABDOMINAL WOUND

  2. The Patient 55 years old Female Married 5 children 22 grandchildren Non-smoker

  3. CO-MORBIDITIES • Diabetic • Hypertension • Coronary Artery Disease • Hyperlipidemia • Probable Sleep Apnea • Obesity

  4. Treatment Course Bypass Surgery 10/01 Dismissed from hospital 10/04 Sternal Wound and Donor Site Infection- Readmitted 10/28 Incision and debridement of leg and sternum - sternum removal 11/06 Closure of chest with muscle flap Debridement of leg wound 11/14 Transferred to NHS Clarkson Hospital 12/05 Hyperbaric Oxygen Treatments Initiated 12/06 Debridement of Sternal/chest/leg wounds - VAC Therapy Initiated 12/12

  5. Treatment Course Debridement of sternal and leg wounds - abdominal wound 01/13 STSG to sternal and leg wounds with VAC therapy 1/20 Transferred from acute care to sub-acute rehab unit 02/05

  6. sternum leg rectus TRANSFERRED TO NHS 12/05 Sternal muscle flap and donor site are open Lower leg is dehisced and infected

  7. sternum leg rectus STERNAL, RECTUS AND LEG WOUNDS IMPROVE QUICKLY 12/12 Use of HBO and VAC therapy along with Multi-disciplinary approach

  8. leg rectus sternum abdomen STERNUM AND LEG GRANULATE ABDOMINAL WOUND DEBRIDED 01/13 Abdominal wound measures 15x10x4cm

  9. sternum leg abdomen SKIN GRAFT TO STERNUM AND LEG 1/20 VAC therapy replaced post skin graft for 5 days

  10. sternum leg COMPLETE TAKE ON SKIN GRAFTS TO LEG AND STERNUM 1/26 At first dressing change grafts have 100% take

  11. abdomen ABDOMEN CONTINUES TO HEAL 2/5 Patient is transferred to Sub-acute rehab floor

  12. INTERDISCIPLINARY PLAN OF CARE • Plastic Surgery • General Surgery • Infectious Disease • Cardiology • Pulmonary Medicine • Endocrinology • Nutrition • Nursing • Physical and Occupational Therapy

  13. STERNUMPHOTOGRAPHIC REVIEW 2 1 3 4 5

  14. RECTUSPHOTOGRAPHIC REVIEW 1 2 3 4

  15. LEGPHOTOGRAPHIC REVIEW 2 1 3 4 5

  16. ABDOMENPHOTOGRAPHIC REVIEW 2 1 3

  17. CASE STUDY #2 SHOULDER WOUND OSTEOMYLITIS REMOVAL OF HARDWARE

  18. THE PATINET • 39 Years Old • Male • 2 Children • Non-Smoker • In Nebraska visiting family

  19. CO-MORBIDITIES • Healthy Young Man • No co-morbidities • Wound occurred when dirt biking

  20. Treatment Course Accident occurred Closed, grossly displaced clavicle fracture 11/10 Presented at ER 11/15 Surgical reduction/fixation with plate and 6 screws 11/24 Released from hospital without any problems 11/25 Presented with signs and symptoms of infection 11/29 Staph cultured – plate and screws noted to be dislodged IV antibiotics initiated 12/01 Plate and screws surgically removed Systemic reaction to Nafcillin and oral dicloxacillin 12/12 Released to home 12/20

  21. Treatment Course Readmitted for further evaluation of non-healing wound 1/23 Surgical resection of mid third of clavicle with debridement of soft tissue infection Infectious disease consulted 1/30 Plastics called in – V.A.C. placed 2/2 Released with home care and V.A.C. 2/7 Clinic follow-up – V.A.C. discontinued-alginate initiated 2/14 IV antibiotics discontinued 2/21 Released from care-healed 2/28

  22. Resection of Clavicle with debridement VAC placed 2/02

  23. ABDOMEN First VAC dressing change 2/05

  24. ABDOMEN Released to home with Home Care 2/07 V.A.C. therapy IV antibiotics

  25. ABDOMEN First Clinic Follow Up 2/14 V.A.C. discontinued Alginate dressing applied

  26. Clinic Follow up 2/21 IV antibiotics discontinued

  27. ABDOMEN Wound is closed  2/28 Hypergranulation area in center Removed with silver nitrate stick

  28. INTERDISCIPLINARY PLAN OF CARE • Plastic Surgery • Orthopedic Surgery • Infectious Disease • Nutrition • Nursing • Home healthcare

  29. CLAVICLEPHOTOGRAPHIC REVIEW 3 1 2 4 5 6

  30. CASE STUDY #3 Perineal cyst Necrotizing Component Radical Surgical Debridement

  31. THE PATINET • 51 years old • Female • Single • Smoker

  32. CO-MORBIDITIES • Diabetic • Hypertension • Hyperlipidemia • Probable Sleep Apnea • Obesity

  33. Treatment Course Presented to Emergency Room with Perineal Cyst Infection Adult Onset Diabetes Mellitus Diagnosis Massive Infection with necrotizing features Emergency Surgery for debridement 1/16 Infectious Disease Consult 1/18 Plastic Surgery Consult V.A.C. Placement 1/24 Sub Acute Care Transfer 1/28 Released to Home 2/28 Healed 4/21

  34. 1/24 Vac placed 18cm – length 7cm – width 5cm tunnel @ 4:00 5cm tunnel @ 9:00

  35. 1/26 18cm length 5cm width 1cm undermining 0 tunnels

  36. 2/14 12cm length 5cm width

  37. 2/19 10cm length 4cm width

  38. Released to Home 2/28 9cm length 4cm width

  39. Clinic Follow-up 3/07 6cm length 4cm width

  40. Clinic Follow-up 3/14 6cm length 3cm width V.A.C. discontinued Normal Saline Moist dressings

  41. Clinic Follow-Up 03/21 6cm length 3cm width

  42. Clinic Follow-Up 03/28 5cm length 3cm width

  43. Clinic Follow-Up 4/05 2.5cm length 2cm width

  44. Clinic Follow-Up 4/13 2cm length 2cm width

  45. 4/21 Healed  Released from care

  46. INTERDISCIPLINARY PLAN OF CARE • Plastic Surgery • General Surgery • Infectious Disease • Endocrinology • Nutrition • Nursing • Home health care

  47. Photographic Review Groin/peri-rectal

  48. 4 2 1 3 8 5 6 7 9 11 10 12

  49. CASE STUDY #4 Perirectal Abscess Necrotizing Component Radical Debridement

  50. The Patient 62 year old Female Widow 2 Children

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