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Wound conditioning before surgical interventions

Texts and images (c) Ligamed

Case report 1 -
Wound treatment with LIGASANO® white on the ankle joint

Patient data and anamnesis:

53 years, male

  • Hereditary polyneuropathy

  • State after brain tumor since the age of 40

  • Ankle fracture 5 years ago; Joint had to be stiffened

  • Alcohol and nicotine abuse

With 50 years occurring ankle pain. Swelling and water retention. The family doctor referred him to the orthopedist. First, bandages, insoles and shoe supply for stabilization. Diagnosis: Arthrosis in the upper ankle.

 

One year later surgery in the hospital. Stiffening of the upper ankle, again orthopedic shoe, pain and swelling continued. Change from the specialist, doubts about the supply.

Performing stiffening of the upper and lower ankle, shortening the fibula by 15 cm to allow the bone material to connect to the forefoot.

Stabilization plate installed. The operation took place in 2015. Placement of a lying plaster for two months. Load with 20 kg with increase to 40 kg in the following two months. Early 2016 Adaptation of a VACO PED shoe for further relief, beginning of a wound situation due to pressure of the shoe in the scar area without pain perception. Wound healing was abducted for several months.

In February 2017, a new wound smear showed a significant germ attack. This was followed twice by the installation of a VAC. In March 2017, she was transferred to BG Unfallklinik Murnau with suspected acute sepsis. After positive wound smear, a high level of antibiosis was given over 6 weeks.

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Fig. 1: In 2015 stiffening of the upper and lower ankle, reduction of the fibula by 15 cm, to connect with the bone material with the forefoot. Installation of a stabilization plate.

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Fig. 2: In April 2017 attachment of an external fixator (stabilization of the ankle with tibia and heel bone). Discharge after 6 weeks, partial load of the heel allowed (crutches).

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Fig. 3: In June 2017, a 3D CT with germ imaging was performed: disintegration of the fibula, upper and lower ankle gastric. Pain therapy despite polyneuropathy (high-dose morphine).

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Fig. 4: July 2017: Inoculation sites are inflamed (material reaction). Supply with LIGASANO® white slit compresses. Pressure relief with customized compression.

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Fig. 5: 17.07.2017 The dressing was changed every two days.

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Fig. 6: 17.07.2018 Sterile slit compresses made of LIGASANO® white were used as primary dressing.

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Fig. 7: 17.07.2017: Secondary dressing and padding with LIGASANO® white.

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Fig. 8: 17.07.2017 Due to the permitted heel load we padded with LIGASANO® white and green for pressure relief. At the same time fix a defect on the lower bale.

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Fig. 9: 17.07.2018 Customization of a compression bandage.

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Fig. 10: In January 2018 decrease of external fixator. For the next six weeks a partial load of a maximum of 20 kg is allowed

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Fig. 11: Part load afterwards with 40 kg. From June 2018 full load on the heel bone allowed. A full load on the entire foot will only be possible in a few years.

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Fig. 12: Supply with a special shoe, 2-fold. Crutch supply. Care and care is provided by the wife. Patient is in early retirement, currently care level 3.

Authors:
Caritas Sozialstation Berchtesgadener Land, Wound Team Christine Kantsperger, Martina Vogel, Dr. med. med. Rudolf Bauer, Siegsdorf, specialist in general medicine

(c) Ligamed

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