1/12. The reversal sural artery neurocutaneous island flap in composite lower extremity wound reconstruction.Reconstruction of the lower third of the leg and the forefoot remains a challenge due to a lack of regional muscle units and minimal subcutaneous tissues. Reverse island flaps have been applied to similar reconstructive problems in the upper extremity. Recently, the reverse sural artery neurocutaneous island flap has been utilized to reconstruct complex wounds of the lower extremity and forefoot in young and middle-aged individuals. We present our use of the flap in a patient cohort 65 years of age or older. Unique among this group was the high prevalence of diabetes and peripheral vascular disease. Nonetheless, the reverse sural artery neurocutaneous island flap proved a safe and reliable means of achieving wound closure.- - - - - - - - - - ranking = 1keywords = closure (Clic here for more details about this article) |
2/12. Use of vacuum-assisted closure therapy following foot amputation.This case study highlights the use of vacuum-assisted closure (VAC) in a diabetic man following a partial transverse amputation of his foot. In this situation infection-free healing is imperative in order to salvage the limb and prevent further trauma. VAC therapy facilitates rapid granulation of wounds and reduces bacterial colonization rates. This method was adopted as a suitable therapy for treatment of a patient who suffered from a complex wound at high-risk of reinfection.- - - - - - - - - - ranking = 5keywords = closure (Clic here for more details about this article) |
3/12. Management of large soft-tissue defects in a diabetic patient.amputation as the only option for treatment of large ulcers in a patient with diabetes is well known. This is a case presentation of a patient with large ulcers and osteomyelitis related to diabetes. He was treated with extensive debridement, segmental shortening, and wound closure.- - - - - - - - - - ranking = 1keywords = closure (Clic here for more details about this article) |
4/12. Autologous human keratinocytes cultured on membranes composed of benzyl ester of hyaluronic acid for grafting in nonhealing diabetic foot lesions: a pilot study.diabetic foot complications are the most common cause of nontraumatic lower extremity amputations in the industrialised world. Unsatisfactory healing requires advanced therapeutic strategies, such as the use of skin grafts, which may represent a helpful option for wound coverage. Alternatively, a method using autologous keratinocytes grown to thin sheet grafts is available. The purpose of this pilot study was to investigate the application of autologous human keratinocytes cultured on membranes composed of benzyl ester of hyaluronic acid (Laserskin autograft) to diabetic foot ulcers. We studied 14 patients with type 2 diabetes mellitus and a nonhealing diabetic foot lesion, defined as existing longer than 6 months or with no wound healing apparent for 12 weeks. Between 7 and 64 days after the transplantation (depending on the size of the ulceration), 11/14 of the lesions were completely healed. The transplantation of autologous keratinocytes may allow faster closure of diabetic foot lesions and subsequently reduce length of hospitalization. This method can easily be planned with regard to logistics and time, and furthermore, this therapy option can be carried out by the diabetologist.- - - - - - - - - - ranking = 1keywords = closure (Clic here for more details about this article) |
5/12. Digital artery flaps for closure of soft tissue defects of the forefoot.Reconstruction of recalcitrant soft tissue defects in the weightbearing surface of the forefoot can be achieved by using a neurovascular island flap. Island flaps, based on a pedicle from either the proper digital artery or the common digital artery, were used to provide supple and durable coverage. A retrospective analysis was performed on 12 patients who underwent a total of 15 digital artery flaps. There were 7 patients with neuropathic ulcers, 7 with a dysfunctional scar, and 1 with an ischemic ulcer after lower-extremity bypass. There was a failure rate of 13%; 2 flaps fully necrosed, necessitating a revisional digital artery flap. Minor complications were reported in 73% of cases; average time to complete healing was 71 days. All healed flaps have remained viable and durable at an average follow-up of 22.5 months from the date of surgery (range, 3 to 61 months).- - - - - - - - - - ranking = 4keywords = closure (Clic here for more details about this article) |
6/12. The vacuum assisted closure of complex wounds: report of 3 cases.Treatment of wounds using conventional methods is frequently limited by inadequate local wound conditions, or by a poor systemic clinical situation. vacuum system may promote faster granulation tissue formation, remove excessive exudate, increase blood flow in the wound, and attract the borders of the wound to the center, reducing its dimension. We present 3 cases of patients with difficult wounds, due to bad local conditions, or poor clinical situation, in whom we used a vacuum system to prepare the wound for the surgical closure. One patient had a pressure ulcer, another had a diabetic foot ulcer, and the third one had an open foot stump. In the 3 cases a significant improvement of the wound conditions was achieved after 7 to 8 days, allowing successful surgical treatment with flap or skin grafts.- - - - - - - - - - ranking = 5keywords = closure (Clic here for more details about this article) |
7/12. The positive experience of using a growth factor product on deep wounds with exposed bone.Trafermin, a form of basic fibroblast growth factor, has been used in japan since 2001. This study investigates whether it can facilitate closure in wounds with deep soft-tissue defects and exposed bone, where surgical closure is not possible.- - - - - - - - - - ranking = 2keywords = closure (Clic here for more details about this article) |
8/12. A unique waterskiing injury leading to a necrotizing foot infection in an insulin-dependent diabetic.Reports of waterskiing-related injuries are limited in the medical literature. The authors report a case of a unique waterskiing injury that progressed into a necrotizing foot infection in a well-controlled insulin-dependent diabetic. This case shows that with aggressive therapy, including hyperbaric oxygen treatments and use of a wound vacuum-assisted closure system, limbs can be saved.- - - - - - - - - - ranking = 1keywords = closure (Clic here for more details about this article) |
9/12. Aggressive conservative therapy for refractory ulcer with diabetes and/or arteriosclerosis.A foot ulcer due to diabetes and/or arteriosclerosis obliterans (ASO) frequently results in an intractable condition that resists treatment. To cope with this condition, we have developed a combination therapy that includes conventional conservative therapy plus surgical therapy. This aggressive conservative therapy using aggressive debridement, trafermin (Fiblast Spray, Kaken, japan) treatment and vacuum-assisted closure (VAC) therapy was adopted to treat seven patients suffering from diabetes and ASO-related refractory foot ulcer accompanied by bone exposure. With the exception of one patient who died during the treatment, the remaining six patients obtained limb salvage. The mean time to cure was 8.3 months. This approach should be considered before amputation. Some patients may refuse amputation or cannot tolerate highly invasive surgical treatment including tissue transplantation. In such cases, this aggressive conservative therapy can be employed as a highly useful and reproducible technique requiring simple techniques.- - - - - - - - - - ranking = 1keywords = closure (Clic here for more details about this article) |
10/12. Diverse applications of negative pressure wound therapy: a multiple case report.The purpose of this retrospective case report was to describe the results of negative pressure wound therapy (NP WT) in the treatment of wounds of various size, location and etiology in four patients. The effects of NP WT were assessed in the following patients. 1) A 68-year-old male diagnosed with cellulitis presenting with two open wounds on the left foot; 2) a 60-year-old male diagnosed with Type II diabetes mellitus presenting with a full thickness wound on the plantar surface of the right foot; 3) a 64-year-old male diagnosed with necrotizing fasciitis, diabetes mellitus, and Crohn's disease presenting with a left gluteal wound; and 4) a 47-year-old obese female diagnosed with necrotizing fasciitis presenting with a wound of the right groin and buttock. All wounds were debrided of devitalized tissue and contained nearly 100% granulation tissue prior to NPWT treatment. NPWT was applied three times per week, each application lasting 48 hrs, followed by dressing change, cleaning of the wound bed and continued debridement as required. Treatment duration, varying from 4-9 weeks, corresponded to the patient's length of stay at the sub-acute rehabilitation facility, and pressure settings ranged from 100 to 200 mmHg. Measurements of wound length, width, depth and appearance were recorded once a week. Follow-up was conducted 6-18 months post treatment to assess self-reported wound status. NPWT resulted in reductions of wound length, width, and depth, with the greatest reduction in each case being wound depth. Reduction in wound depth ranged from 75-100% (100% being complete wound closure), with four of the five wounds exceeding 90%. Reduction in wound length ranged from 32-100%, with three wounds exceeding 80%, and reduction in wound width ranged from 35-100%, with three wounds exceeding 80%. Three wounds closed completely either during therapy or soon (2-4 weeks) thereafter, and two wounds were reduced in size sufficiently for treatment via skin grafts. NPWT, applied to wounds of diverse size, location, and etiology, resulted in reductions in wound length, width, and depth in four patient cases, with the greatest influence of reducing wound depth.- - - - - - - - - - ranking = 1keywords = closure (Clic here for more details about this article) |
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