Here - EWMA 2013

POSTER: CASE STUDY
Poster: Case Study
P 350
THE USE OF ACELLULAR DERMAL MATRIX AND SKIN GRAFTING IN
THE TREATMENT OF HEEL PRESSURE SORES
Kristen Aliano 1 , Steve Stavrides 1 , Bobby Mathews 1 , Thomas Davenport 1
1 Long Island Plastic Surgical Group (Garden City, United States).
Aim: The heel is the second-most common site for pressure wound development and
has a high prevalence. Moreover, they can be difficult to prevent and treat, especially in
patients who are elderly, malnourished, or have underlying medical conditions such as
diabetes and peripheral vascular disease. In many circumstances, these wounds are
extensively debrided or the patient ultimately undergoes partial calcanectomy and other
amputations, thereby severely limiting the patient’s ambulation and overall level of
functioning. Here, we present a series of two patients whose calcaneal pressure ulcers
were treated with acellular dermal matrix (ADM) and split-thickness skin grafting.
Methods: One patient was a middle-aged male with a foot drop who was non-compliant
with his foot brace. In consequence, he developed a mid-plantar wound. The other was
an elderly female who developed a posterior heel wound. Both patients were taken to
the operating room where ADM was applied directly to their wound beds after
debridement. After two weeks, an autologous split-thickness skin graft was then applied
to the neodermal bed.
Results: The patients tolerated the procedure well and there were no complications. In
the post-operative months, the wounds of all patients healed completely, and the
patients had excellent functional outcomes with a return to ambulation.
Conclusions: Although further research with larger sample sizes is needed, based
upon our experience, we feel that the combination of ADM and split-thickness skin
grafting is a beneficial means of surgically treating heel pressure sores and preventing
calcaneal osteomyelitis.
P 351
MANAGEMENT OF HAND PRESSURE SORES
Poster: Case Study
Kristen Aliano 1 , Steve Stavrides 1 , Bobby Mathews 1 , Thomas Davenport 1
1 Long Island Plastic Surgical Group (Garden City, United States).
Aim: Pressure sores most commonly occur on the sacum, heel, and ischium. However,
an uncommon location for such wounds is the palm of the hand. They typically occur in
flexion contracures of the hand on the setting of spasticity or chronic contractures.Here,
we report two cases of palm pressure wounds from hand contractures.
Methods: The two patients chosen for inclusion in this series had full-thickness wounds.
One patient had a sore that covered the palmar surfaces of the hands from the index to
ring fingers. The second patient had a fingertip wound at the paronychia. The fingers in
that patient were inflexible and dressings could not be applied secondary to the
contractures.
Results: In the first patient, the contractures were the result of finger pressure from
spasticity resulting from cerebrovascular accident. After the failure of splinting therapy,
the patient was treated surgically by tendon release and splinting. All wounds healed
completely with no recurrence. The second patient had finger wounds secondary to
spasticity from a closed head injury. Splinting alone was unsuccessful. This patient was
healed with Botox injections to the profunda and superficialis muscles. The hand
spasticity improved and the finger wounds healed spontaneously with splinting.
Conclusions: Hand ulcers secondary to spasticity are often difficult to treat. Botox and
surgery can be useful means of treating these wounds.
EWMA 2013
COPENHAGEN
15-17 May · 2013
Danish Wound
Healing Society
205