Surgical applications of external fixator, negative pressure wound therapy (NPWT) and application of skin substitutes for complex lower extremity wounds: Multiple Case Report
Introduction: A collection of multiple case reports was compiled on various patients with significant co-morbidities and complex wounds who were at high risk for amputation of the affected limbs. Patients are often faced with complications including long hospital stays, wound infection, osteomyelitis and limb loss due to challenges associated with healing full-thickness wounds. With no clear consensus regarding the best methodology for closure, the technique applied each time is largely the surgeon’s preference. In this multiple case report, various advanced wound closure methods in multiple cases are assessed.
Methods: Multiple case reports including male patient with chronic ulceration and deformity requiring application of external fixator and Jacob’s ladder suture technique; female patent with severe sepsis, critical limb ischemia requiring emergent partial amputation then application of skin graft and NPWT; male patient with dislocated hallux and failed skin autograft requiring application of skin substitute and NPWT; male patient with diabetes and osteomyelitis underwent partial amputation requiring application of skin substitute and NPWT; male patient with acute onset compartment syndrome received multiple fasciotomies of the leg, resulting in a total of five wounds requiring meshed fish skin grafts with bridging between wound sites and NPWT.
Results: Complete or near complete wound closure was achieved for all cases. Advanced adjunct therapies in combination with conventional wound therapy including weekly wound debridement and application of NPWT three times weekly achieved favorable outcomes for all patients.
Discussion: A combination of skin grafts, NPWT, external fixators and other advanced modalities are often required for patients with complex medical conditions for limb salvage. The wounds showed an earlier buildup of granulation tissue. The results had good cosmetic and functional outcomes for the patients.
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