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Case Study
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Decreasing the risk of limb amputation with the use of an antimicrobial nanocrystalline silver barrier dressing* Shay Dean, MD, University Of North Carolina at Chapel Hill A silver-coated antimicrobial barrier dressing* was used to assist healing of exposed tibia after failed gastrocnemius and soleus flap reconstruction of an open tibia fibular fractures..Patient: A 29-year-old man sustained complex tibia and fibula fractures in a motor vehicle accident. The wound was debrided and the tibia and fibular fractures were reduced and externally fixed; ankle and patellar fractures were internally fixed. The patient required tracheostomy for assistance with ventilator weaning and improved pulmonary support for pseudomonal pneumonia. Plastic surgery consultation was initiated to provide coverage of this open wound with middle and distal tibia exposure Treatment: We performed a local gastrocnemius flap and soleus flap for attempted coverage of a wound approximating 20 X 8 cm, with 10 x 5 cm of exposed bone. The inferior aspect of the wound dehisced, with exposure of 5 x 2.5 cm of bone at the junction of the lower and middle third of the tibia. A decision was then made not to use free tissue transfer for wound coverage, but to use a nanocrystalline silver-coated antimicrobial barrier dressing* with the synergistic use of a tissue vacuum assisted compression (VAC) device. The VAC was placed over the silver dressing and changed every forty eight hours for two weeks and one month as an outpatient. The silver dressing was used to accelerate and heal this complex wound, thereby avoiding free tissue transfer Outcome: Wound healing occurred 6 weeks after the silver dressing application. The exposed bone was covered with healthy granulation tissue. Elective skin grafting was offered to the patient, but declined. He has started physical therapy to regain strength and the ability to ambulate. The associated morbidity of free tissue transfer and health care costs were avoided, while resulting in a healed wound *ACTICOAT, Smith & Nephew Wound Management Inc., Largo, FL |
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