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Case Study #25
63 y.o. male presented on 10/2010 with Type II diabetes and a recurrent ulcer under the right first metatarsal head. All symptoms of a serious diabetic foot infection. Skin perfusion pressures were >50 mmHg, ruling out significant peripheral artery disease.
Case Study #24
60 y.o. female presented on 2/22/2010 with spontaneous bacterial peritonitis. She had a history of metastatic abdominal carcinoid. On 2/24 surgery was performed and the abdomen open due to and secondary to exploratory laparotomy with grossly infected peritoneal fluid. On April 14th following eight weeks with no wound healing we decided to place DermaClose RC continuous external tissue expander. Prior attempts to heal the wound were unsuccessful.
Case Study #23
This 38 year old male patient presented with a cramp in his lower right leg. Further analysis revealed this to be 'Deep Vein Thrombosis' (DVT) which resulted in Compartment Syndrome, necessitating a Fasciotomy of the lower right leg. The resulting wound measured, 35cm x 20cm at the widest point.
Case Study #22
This 36 yr old morbidly obese diabetic female patient originally presented with multiple incisional hernia in 2008. Hernias were treated with a succession of mesh products commencing with a non-biologic before progressing to a biologic mesh in Sept. 2009.
Case Study #21
This patient is a 54 year old male with Buerger’s disease
and a non-healing ischemic ulcer to the dorsum of his
left hallux for almost two years. He has a 30 pack per
year smoking history and quit a year ago.
Case Study #20
On 12/07/2009 this 14 yo/s injuries were the result of getting caught in a boat propeller. He underwent an above the knee amputation of the left leg and an achilles tendon repair on the right and a rotation fasciocutaneus flap used to cover tendon due to missing overlying skin. Post-op infection required debridement of the flap distally. The infection was controlled but a large defect over tendon remained.
Case Study #18
On 9/29/08 a 31 year old male presented to the trauma
bay with a gunshot wound (GSW) to the left popliteal
fossa. On exam the patient was found to have no
palpable pulses in the left foot, with no sensation to
touch and an inability to move the foot. X-ray revealed
a comminuted distal femur fracture. The patient was
take to the OR where first Orthopedics rodded the
fracture to stabilize it.
Case Study #17
S.B is a 47 y/o male with a past medical history significant for depression and recurrent left Achilles tendon ruptures, chronic wound to
the left leg 13 months duration and depression. S.B's past surgical history was significant for three open Achilles tendon surgical procedures
including primary repair of an acute rupture, delayed repair of the Achilles tendon with augmentation with an allograft and a flexor hallucis tendon transfer with left hallux interphalangeal joint arthrodesis.
Case Study #16
This 45 y.o. male presented with an abscess on the plantar aspect of the 1st metatarsal. He was admitted to the
local hospital and on the same day underwent an I&D procedure. His WBC count on admission was 13,000
and he had fever of 101.4. Intra-operative findings demonstrated abscess formation within the medial compartment
of the plantar left foot.
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.
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.
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