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Case Study
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Case report: using dual therapies of a negative pressure wound therapy and modified silicone gel liner to treat a limb postamputation and dehiscence Paula S. Pattison, RN, BSN, CWOCN, Jonathan K. Gordon, MD, FACS, CWS, Paula M. Muto, MD, FACS, John K. Mallen, MD, Jeffrey Hoerner, PT, CPO PURPOSE: This case study illustrates a positive outcome using dual therapy of negative pressure wound therapy (NPWT) and a modified silicone gel liner to treat a nonhealing, dehisced incision following a below-the-knee amputation. The primary goal of using the two therapies together was to reduce recuperation time by simultaneously closing the wound while actively reshaping and shrinking the limb residuum for a prosthesis which in turn enhanced the patient's sense of control and self worth STUDY: This study illustrated that after 26 days of combination therapy with NPWT and the silicone gel liner, the wound length and width measurements had decreased by 50%, and the depth and tunneling were reduced to 0.0 cm. The wound was 100% granulated to the surface. The diameter of the residual limb was reduced from 38.5 cm to 36.0 cm, and the limb contour was reshaped from oval to cylindrical. Three days after the discontinuation of NPWT, the patient was fitted with a prosthetic leg. Prior to incorporating these dual therapies concurrently, our standard of care for a BKA wound was to apply NPWT until the wound closed and then shrink and reshape the limb residuum. This 2-step approach could take approximately 30-60 days longer OUTCOME: By using dual therapy NPWT and a modified silicone gel liner for limb reshaping and shrinkage the rehabilitation process was acclerated. Dual therapy decreased the number of days for prosthetic fitting, offered mobility and a high sense of self worth and control for the patient. This process decreased physical therapy time and the overall number of prosthetic fittings CONCLUSION: By using dual therapy of NPWT and a modified silicone gel liner for limb reshaping, recuperation time was significantly reduced. In today's world climate this is a noteworthy standard for care. Pattison PS, Gordon JK, Muto PM, Mallen JK, Hoerner J. Case report: using dual therapies-negative pressure wound therapy and modified silicone gel liner- to treat a limb postamputation and dehiscence. WOUNDS. 2005;17(8):233Ð240 Webb LX. New techniques in wound management: vacuum-assisted wound closure. J Am Acad Orthop Surg. 2002;10(5):303Ð311 Herscovici D Jr, Sanders RW, Scaduto JM, Infante A, Dipasquale T. Vacuum-assisted wound closure (VAC therapy) for the management of patients with high-energy soft tissue injuries. J Orthop Trauma. 2003;12(10):683Ð688 Petrie N, Potter M, Banwell P. The management of lower extremity wounds using topical negative pressure. Int J Low Extrem Wounds. 2003;2(4):198Ð206 Saxena V, Hwang CW, Huang S, Eichbaum Q, Ingber D, Orgill DP. Vacuum-assisted closure: microdeformations of wounds and cell proliferation. Plast Reconstr Surg. 2004;4(5):1086Ð1095 Joseph E, Hamori CA, Bergman S, Roaf E, Swann NF, Anastasi GW. A prospective randomized trial of vacuum-assisted closure versus standard therapy of chronic nonhealing wounds. WOUNDS. 2000;12(3):60Ð67 Stanhard J. Complex orthopaedic wounds: prevention and treatment with negative pressure wound therapy. Adv Skin Wound Care. 2004;17(1):3Ð10 Johannesson A, Larsson G-U, Holmquist A, Larsson B, Lower extremity amputations: an aggressive prosthetic management technique. Presented at the 25th Annual Meeting of the American Academy of Orthotists and Prosthetics in New Orleans, LA, March 5, l999 Larsson G-U, johannesson A, Holmquist A, Larsson B. Lower extremity amputations:a controlled active treatment protocol. Presented at the 25th Annual Meeting of the American Academy of Orthotists and Prosthetists in New Orleans, LA, March 5, 1999 Smith DG, Berke GM, Blanck R, et al. Post-operative management of the lower extremity amputee (official findings of consensus conference). J Prosthet Orthop. 2004;16(3S):2Ð14. |
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