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Case Study
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Healing a 7-year-old leg ulcer in a 37-year-old immunosuppressed male host with HIV using VAC therapy* over STSG Alan Cantor, DPM, Donna Hangan, NP, Paul Scott, MD A 37-year-old man, with HIV and a critically low T cell count was referred to our center for management of a chronic, large left leg ulcer due to intravenous drug abuse and multiple episodes of phlebitis A large, malodouros, heavily exuding leg ulcer was observed. The patient previously was refusing anti-viral therapy and was advised that wound healing and limb slvage were unliely without full compliance with local and systemic therapies Serial debridments were performed with the VersaJet Hydrincision system, and application of VAC therapy applied after each debridemnt. Once an optimized wound bed was achieved and patients T cell count was elevated, he was brough to the OR for application of STSG. STSG was applied, but the surgical team refused to apply a VAC to the graft site. Subsequntly, the patient was found to have 100% graft loss on post op day #2 He was returned to our care for wound management and wound bed optimization. VAC therapy over silver dressings were applied again, and the patient was returned to the OR for application of a second STSG. After application of the STSG, VAC therapy was applied in the OR immediately after graft placement Follow up revealed 100% graft incorporation and the patient went on to complete healing without any complications or relapse of the ulceration The authors advocate the esential need for optimized wound bed preparation prior to any skin closure procedure and demonstrate in this case that immediate application of VAC therapy on a graft permitted a succesful outcome when compared to no VAC therapy. VAC therapy has demonstrated to our service enormous value and healing capabilities over numerous soft tissue surgical closure procedures. Additionally, systemic diseases must be co-managed aggressively to permit local wound healing *V.A.C.ยจ, KCI USA, San Antonio, TX |
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