Here - EWMA 2013

POSTER PRESENTATIONS
P 416
TREATMENT EXPERIENCE of SECONDARY VASCULITIS WITH
EXTENSIVE SKIN NECROSIS
Poster: Case Study
G.P. Kozinets 1 , Alexander Voronin 1 , V.P. Tsygankov 1 , N.P. Isaenko 1 , Y.A. Solodky 1
1 Center thermal trauma and plastic surgery (Ukraine).
Introduction: Vasculitis of skin – group of diseases, which combines lesions of small
skin vessels with the development of necrotic changes of skin. Vasculitis are associated
with occurrence of allergic reaction to any antigen – exogenous or endogenous.
Objective: Comprehensive treatment development of patients with vasculitis signs with
skin extensive necrosis.
Materials and Methods: Patient, age 41, was brought into Thermal Trauma and Plastic
Surgery Kiev Center, with diagnosis: necrotizing vasculitis with skin and mucous
membranes lesions, total area – 40% of body surface. Necrotic tissues were located on
upper and lower extremities, draining and limited. Depth of necrosis – skin,
subcutaneous tissue. Patient polymerase chain reaction contained: CMV – 619, Epstein-
Barr virus – 1221, herpes virus type 6 (NNV6) – 1243 at norm rate – 110.
Treatment: Transfusion detoxifying therapy, desensibilization therapy, systemic
antibacteria therapy, according to the sensitivity of microflora, wounds symptomatic
therapy. Specific antiviral therapy: Bioven mono, Ganciclovir, Polioksidoniy. Subfascial
necrosectomies were carried out, 14 autodermoplastics operations on total area 4900
cm 2 with full engraftment autodermografts were performed. The disease had an
undulating character, with periodic recurrence vasculitis phenomena on previously nonaffected
areas of body, but manifesting changes did not lead to deep necrotic changes
of skin and underwent to self-epithelialization. Condition changes required repeated use
of antiviral therapy complex including therapeutic plasmapheresis treatment sessions (3
sessions) in program. The patient’s condition was stabilized. Patient was discharged
from hospital. Residence time of treatment was 136 days.
Conclusion: Treatment of patients with this pathology has 2-components and includes
landmark surgery on background of specific therapy.
POSTER: CASE STUDY
P 417
Poster: Case Study
APPROACH IN TREATMENT OF POSTOPERATIVE DIABETIC WOUNDS WITH
SIMPLIFIED NPWT* AND SKIN SUBSTITUTE COVERAGE
Nadja Alikadić 1 , Adrijana Debelak 1 , Dragica Maja Smrke 1
1 Institution is University Clinical Center Ljubljana (Ljubljana, Slovenia).
We describe a case of 44-year old male diabetic patient in whom skin and soft tissue
necrosis was diagnosed four days after successful below knee amputation. Amputation
was performed due to severe diabetic foot osteomielitis and soft tissue infection. The
necrotic postoperative wound progressively developed due to acute postoperative renal
failure and subsequent fluid retention in the wound. At first, in acute stage of patient’s
renal failure and subsequent respiratory insufficiency, the wound was treated
conservatively with regular antiseptic dressings and systemic antibiotics. After the
patients stabilization and prompt renal insufficiency treatment the surgery therapy was
performed again. Standard surgery treatment with intensive debridement of necrotic
tissue was applied. The open wound was treated with a simplified* negative wound
pressure therapy (NPWT). The simplified* NPWT was applied three times, duration of
each treatment was five days. During the short treatment time of two weeks we achieve
excellent wound bad preparation with formation of good and healthy granulation tissue.
The wound was ready for coverage with autologous skin Mesh graft transplants. In time
of six weeks the postoperative wound was healed and patient was ready for application
of below knee prosthesis. In conclusion, our case suggests that described new approach
in treatment of open wound with a simplified* NPWT followed by autologous skin
substitutes coverage is effective approach in the management of open post operative
wounds in diabetic patients.
*PICO
238