2007 SAWC Clinical Poster Presentation
Case Study #15
This is a 48yo 430-pound diabetic male that sustained a left heel puncture wound from an unknown object while in New Orleans as a relief worker following Hurricane Katrina in August of 2005.
Case Study #14
This is a 68 y/o poorly controlled diabetic that
originally presented to the office complaining of a
malodorous foot that was not responding well to 6
weeks of Vaseline on a dead plantar midfoot. The
patient was found to be septic and in acute renal
failure. He was admitted to the hospital.
Case Study #13
Patient is a 60-year-old female with diabetes mellitus. On 12/31/07, patient underwent fifth ray amputation
due to osteomyelitis on fifth metatarsal. She previously underwent a below-the-knee amputation of the left
over two years ago.
Case Study #12
Patient is a 58-year-old male with diabetes mellitus who on 12/01/07 underwent partial first ray amputation
that was left open. This was performed due to osteomyelitis of the first metatarsal. He was getting wet-to-dry
dressing changes on daily basis along with local wound care. After extensive surgical debridement the
wound measured 4.0 x 2.5 cm x 1.5 cm deep.
Case Study #11
A 42 year old African-American male presents to our clinic after stepping on a bottle cap in March 2007. The patient is a poorly controlled diabetic with serum glucose running between 250 and 350 mg/dL. His medications include oral hypoglycemics, injectible Insulin and cholesterol lower drugs.
Diabetic Foot Case Study
Closure of large wounds has been a challenge in podiatric surgery, especially after large defects created by ulcer debridement, metatarsal resection and amputation. The DermaClose™ RC tissue expander allows for closure of large defects without the need for traditional complex skin closure, tissue grafting or creation of skin and tissue flaps. Skin anchors made of surgical steel clips are used with a tension controller to allow for gentle skin stretching on the subcutaneous planes of the wound or defect. It also has special application in the closure of chronic wounds. Two case reports are presented to describe this technique.
Case Study #9
4/10/2007 – This 36 year old male presented with a recurrent nevus on the central chest previously excised in childhood. The patient was bothered by the recurrence of pigment as well as by the appearance of the scar, which had widened over time. We therefore decided to re-excise the entire lesion. The patient was placed in the supine position on the operating table. The mid chest scar with recurrent nevus was outlined and then anesthetized with 1% lidocaine with epinephrine. The area was then prepped and draped in the standard sterile fashion. Full thickness excision to subcutaneous fat was performed on the entire seat of the scar including the recurrent nevus. The defect measured 9.8 x 4.5cm. The DermaClose external tissue expander was then used to begin the complex closure.
Case Study #7
4/19/2007 – This is a 61 year old female with a history of T9 paraplegia due to a motor vehicle accident when
she was 34 years old. She initially developed a stage IV sacral decubitus ulcer in November 2005. The ulcer led
to Osteomyelitis requiring surgical debridement and myocutaneous flap. The patient did well for almost a year.
She then developed bilateral stage IV gluteal decubitus ulcers. She again underwent surgical debridement and
bilateral myocutaneous flaps. The patient was also placed on an air fluidized bed and negative pressure wound
therapy (VAC) was applied to the wound. The VAC was discontinued on 03/09/07. At that the time wound
measured 1.1 cm x 2.5 cm with tunnel now measuring 3.8 cm. There was wound edge contraction with a well
granulating wound bed with no clinical evidence of infection.
Case Study #6
This 6 x 4 cm wound located on the posterior right calf was treated with the DermaClose™RC for only 70 minutes. This was enough time to expand the adjacent tissue, thereby enabling closure by primary intention. The procedure was performed under local anesthesia.
Case Study #5
This 55-year-old male presented with melanoma of the left calf measuring 3.4 cm. Due to its size and location we elected to use the DermaClose RC external tissue expander. The area was prepped and 1% Lidocaine with epinephrine was infiltrated.
Following the winding of the tension controller the wound was approximately 60 to 70% closed. The DermaClose device was left in place for approximately 45 minutes at which time the wound was approximately 75% closed. The final length after closure was 6.8 cm and the procedure was performed without any complications
Case Study #4
This 75-year-old male presented with atypical fibroxanthoma
of the vertex scalp. Mohs surgery was completed
leaving a final defect measuring 3.0 x 3.0 cm in size. The DermaClose™RC device was put in place. The wound was
then dressed with a pressure dressing and the patient was
instructed to return in the next day for evaluation. The
wound was then closed. The patient tolerated the procedure
well and left the operating suite without complications.
Case Study #2
This 85-year-old male presented with a large squamous
cell carcinoma of the left lower arm measuring 4 x 3.5 cm.
The Mohs surgery was completed leaving a final defect
measuring 5.3 x 4.4 cm in size. The DermaClose™RC was
applied and upon returning the following day the wound
had continued to reduce in size to 1.5 x 2 cm. The Derma-
Close™RC was removed and five 4-0 Vicryl deep sutures
were placed. The cutaneous margin was re-approximated
with a running 4-0 Prolene horizontal mattress suture and
several simple interrupted 5-0 Ethilon sutures. The wound
was healing nicely at eight week follow-up.
