Hard to Heal Wounds

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Hi, this is Tim Oldani, a podiatrist in St. Louis. I'm going to run through a couple cases of hospital patients I picked up on hard to heal wounds. The first gentleman, a 67-year-old diabetic with neuropathy had a lateral foot infection that probed into the fifth MPJ.

He required surgery, a right fifth metatarsal amputation as well as toe amputation, and also a pretty extensive debridement and I & D within his medial arch. So, after surgery, arterial studies look good. He didn't require any vascular intervention.

He was subsequently discharged with negative-pressure wound therapy, as well as a PICC line that infectious disease was managing. And I saw him back in the office for the first time on January the 14th. So this is what his foot looked like for his first office visit. So at that time, he's in pretty big danger of losing this foot. So we decided to throw everything we could at this wound.

We used the InnovaMatrix AC underneath the NPWT for about the first 2-to-3 weeks as this wound continued to granulate in. So I'll run through these pictures. These are weekly pictures.

You can see a medial wound still shows that plantar fascia on the bottom. But the lateral wound is really starting to granulate in nicely. Each week he was requiring a little bit less debridement laterally, a little bit more medially, until we could get all that tissue to granulate in. So, by February the 18th you can see both are completely granular, no longer needing any debridement, no longer needing any NPWT. He continued to come in weekly, a couple of times it was every other week just because of scheduling issues, but he was receiving grafts at this time. You can see not only is the tissue very healthy, but also you can see that the wound is getting much smaller, both width and length.

So this is April, essentially 4 months out from surgery and hospitalization and he's getting close to healed on both of those. By June, or excuse me, May the 20th, he's completely healed on the lateral wound and almost healed on the medial wound. And then you can see his last office visit on June the 17th. He's completely healed on both. So nice result for him. Not quick, but 6 months compared to what it looked like to begin with was pretty impressive.

Similar story here, a 53-year-old diabetic with neuropathy and a pretty nasty diabetic foot infection. He came in as well, arterial studies, X-rays, same workup. He ended up having 2 different surgeries, two I & Ds, and then a partial fourth and fifth ray resection on the right. So here's his first office visit.

You can see he's got some good granulation tissue and still some tendons visible distally, but overall the wound looks pretty good and then we started doing, you know, InnovaMatrix AC grafts on him. So same story coming in weekly, grafts are applied. You can see we're already starting to get some closure over those tendons with granular tissue.

Can't see the tendons anymore by July 6th, so that's roughly 4 or 5 weeks after we started doing the grafts. He hadn't required too much debridement either in the office and again you can see the nice result. Wounds getting smaller, tissues healthy, no more more debridement, smaller again.

By the end of August still a fairly good size wound, but no depth to it. He was continuing to come in, he started to show up a little bit less frequently, but grafts each time he came in, and then if we fast forward to December the 28th, then he's completely healed and that is roughly about the same timeline as the other, approximately 6 months from hospital to closure. So another good result in a limb that was at high risk for amputation at the time. Thank you.