How I Treat: Complex Wound Closure Case Presentation
Sponsored
Aseptically Processed Human Allografts Use in Complex Wound Closure
Author Name
Frank Nastanski, MD, Orange County Global Medical Center, Santa Ana, CA
Patient Presentation
Case 1
- 58-year-old male
- Past medical history included hepatitis C as well as methamphetamine and heroin use
- The patient presented with a cut to his left knee from a fall while “urban camping” that had progressed to cellulitis in his entire leg with pus draining from the wound
- The infection affected the skin, muscle, fascia, joint capsule, and some areas of periosteum, which required aggressive serial debridement (Figure 1)
Case 2
- 41-year-old female
- Past medical history included morbid obesity and type 2 diabetes
- The patient presented with an abscess to the buttocks that had progressed to necrotizing fasciitis of the perineum bilateral buttocks and sacrum, which required 2 rounds of debridement with IV antibiotic therapy (Figure 2)
Procedure and Treatment
Case 1
- After the infection was controlled, meshed human reticular acellular dermal matrix (HR-ADM) was secured to the wound bed using temporary surgical staples, and negative pressure wound therapy was applied
- After 10 days, the knee and lower leg received skin grafts, with autografting of the upper leg and hip 4 days later (Figure 3)
Case 2
- Once the infection was cleared, tunneling wounds of the right buttock and ischiorectal fossa were closed using soft tissue advancement flaps
- The dead space was filled using meshed HR-ADM, which was also utilized to maintain contour and avoid fluid collections
- Contour and bulk were created in the area by injecting allograft adipose matrix into the fatty tissues, and dehydrated amnion/chorion membrane was applied to the wound to support skin grafting (Figure 4)
Clinical Outcomes
Case 1
The wound was nearly closed and the knee had near normal range of motion within 6 weeks (Figure 5)
Case 2
The patient was fully continent of stool and flatus at 4 weeks (Figure 6)
