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Case Study
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Utilization of bi-layered living skin construct to treat leg wound with exposed tendons secondary to necrotizing fasciitis Desmond P. Bell, Jr., DPM, CWS, FCCWS, FAPWCA, First Coast Diabetic Foot & Wound Management Center, Jacksonville, FL Necrotizing fasciitis of the lower extremity is an aggressive limb threatening condition which is a true medical emergency. Prompt treatment in the form of decompression and aggressive debridement of the affected limb is critical not only for limb salvage, but in preventing systemic sepsis A woman with diabetes sustained an ulcer at the first interspace of her left foot from wearing Òflip-flopÓ type sandals. A fulminant infectious process resulted in rapid proximal progression of necrosis from the foot along the medial compartment of the leg. Extensive incision and drainage of the foot and leg was performed times three and intravenous antibiotics were started Resulting surgical wounds along the medial leg revealed exposed muscle and tendons including those of the tibialis posterior and flexor digitorum longus. Bi-layered living skin construct was cut and fenestrated to cover the deficit and exposed tendons along the medial leg. Wound bed preparation included negative pressure therapy which was also utilized for one week after the graft application. A compression dressing consisting of an Unna boot and elastic self adherent wrap was applied and changed twice weekly after graft application. The bi-layered living skin construct was found to promote rapid contracture of the wound with new epithelialization observed. Additionally, new granulation was observed over previously exposed tendons within 2 weeks of graft application with increasing coverage seen at each subsequent dressing change Wound beds rich in granulation tissue remain the optimal setting for living bi-layered skin construct application. However, the presence of exposed tendon, especially when juxtaposed with significant granulation tissue, should not be perceived as a deterrent to graft application and ultimately successful outcomes. |
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