Comparison of Satisfaction Levels between Conventional and Silicone-Adhesive Polyurethane Foam Materials in Patients with Skin Wounds

Ha Hyun Jeong,Yang Jun Young,Kim Chan Woo,Jeong Seong Heum,Hwang Euna 대한창상학회 2021 Journal of Wound Management and Research Vol.17 No.3

Background: Polyurethane (PU) foam dressing materials have been widely used in commercial wound dressing applications. However, the repeated application of adhesive tapes to keep the foam dressings in place can result in minor injuries to the peri-wound skin. Silicone-adhesive PU foam dressing materials have been developed to prevent such injuries. In this study, the satisfaction levels between conventional and silicone-adhesive PU foams were assessed through a survey of patients and physicians.Methods: A survey study of 140 patients with skin wounds was conducted in a single institution between July 2019 and May 2020. The patients were first treated with either conventional PU foam or silicone-adhesive PU foam, after which they were asked to record their levels of pain, adhesiveness, waterproofness, and satisfaction. At the next visit, dressings of the other material were applied to their wounds, and the same assessment process was repeated at the next dressing change.Results: The silicone-adhesive PU foam dressings demonstrably reduced the levels of dressing-related trauma and pain, compared to that of patients treated with conventional PU foam dressings. The silicone-adhesive PU foam dressings were also associated with substantially higher scores of satisfaction and waterproofness. In comparison, the mean adhesiveness score was superior in the group treated with conventional PU foam dressings, compared to that of the group treated with silicone-adhesive PU foam dressings.Conclusion: Silicone-adhesive PU foam contributed to minimizing pain during dressing change and increasing patient’s comfort. As a result, patients preferred dressing with silicone-adhesive PU foam over conventional PU foam.

Reconstruction of Lateral Malleolar Defects: Adipofascial Turnover Flap Based on the Peroneal Artery Perforator

Yeo Hyeonjung,Lee Sanghun,Park Hyochun,Park Hannara,Kim Hyodong,손대구 대한창상학회 2022 Journal of Wound Management and Research Vol.18 No.1

Background: Lateral malleolar defects are a commonly encountered clinical issue, with several treatment options available from local flaps to microsurgical reconstruction. However, ankle defects are difficult to manage, especially in patients with comorbidities. We report here our experience of lateral malleolar reconstruction using adipofascial turnover flaps based on the peroneal artery perforator. Methods: A total of nine patients who underwent peroneal artery perforator-based adipofascial turnover flap coverage from December 2011 to February 2016 were retrospectively evaluated. Data were collected on the patients’ age, sex, etiology, comorbidities, anesthesia type, combined surgery, presence of osteomyelitis, bacterial profiles, vascular status, defect size, flap size, flap elevation time, follow-up period, and complications. Results: The mean age of the patients was 66.4 years. The most common cause of the wound was pressure injury. Seven patients had one or more comorbidities, and four patients were current smokers. Three patients were diagnosed with chronic osteomyelitis. Percutaneous transluminal angioplasty was performed in two patients. The mean defect size was 8.4 cm2, and the mean follow-up period was 30.7 months. All nine flap transfers were successful without major complications. However, in one case, partial skin graft loss occurred, requiring additional skin grafting. Conclusion: The peroneal artery perforator-based adipofascial turnover flap is a safe and reliable method to reconstruct lateral malleolar defects. The operative technique is simple and convenient to perform and hence a useful option for reconstructing lateral malleolar defects. This is especially true for patients with comorbidities who are typically not indicated for more complex procedures.

Closed Irrigation System for Wound Management of Complicated Ischial Pressure Ulcers

성건용,이상열 대한창상학회 2021 Journal of Wound Management and Research Vol.17 No.1

In patients with complicated ischial pressure ulcers, surgical repair is often delayed until the general condition of the patient improves, and in extremely ill patients, surgery might never be performed. Since deep ischial ulcers are usually associated with a profuse discharge, large sinus cavity, and are adjacent to the anus, maintaining effective dressing is challenging for surgeons. In order to manage such ischial ulcers, we devised a closed irrigation system using the Barovac (50–90 mmHg) wound drainage device and a saline infusion set. The system was applied to a 50-year-old paraplegic man who was diagnosed with impending sepsis due to a longstanding ischial ulcer with secondary infection. Using the saline infusion set, we infused 200 mL of saline into the ischial cavity every 6 hours in the ward. After a 10-minute dwell time, the fluid in the cavity, including the exudate and wound debris, was drained continuously through the wound drainage device. This system was very helpful in keeping the patient’s ischial wound clean until his general condition improved and surgical repair could be undertaken. We therefore believe that our closed irrigation system provides an effective, convenient, and inexpensive dressing method for patients with complicated ischial wounds.

Reconstruction of Plantar Forefoot in Diabetic Foot Ulcers: A Comparative Study of Perforator Flaps and Random Flaps

김윤섭,Si-Gyun Roh,김종림,이내호,신진용 대한창상학회 2021 Journal of Wound Management and Research Vol.17 No.1

Background: Plastic and reconstructive surgeons consider a variety of options to salvage limbs of patients when operating on soft tissue defects of the plantar forefoot in diabetic foot ulcers. This study focuses on the efficacy and durability of perforator flaps compared to that of random flaps, when covering the plantar forefoot area in diabetic patients. Methods: From January 2011 to August 2020, we performed 49 plantar forefoot reconstructions to cover soft tissue defects in diabetes patients using local random flaps, regional perforator-based flaps, or free flaps. The patients’ clinical characteristics, size of defects, surgical outcomes and complications were reviewed retrospectively. Results: Forty-nine patients underwent plantar forefoot reconstruction over the period reviewed. Eleven patients were female and the others were male. The mean age of the patients was 54.2 years (range, 32–73 years). Median follow-up was 5.2 months. The mean size of the defect was 7.2×4.5 cm. During follow-up periods, partial or complete loss of flaps was closely observed. We identified wound complications in 67% of local random flaps compared to 11% and 21% in regional and free flaps, respectively. Conclusion: Soft tissue defects in the distal third of the foot can severely worsen diabetic patients’ quality of life. Perforator-based flaps, providing better vascularized tissue than random flaps, can be used to attain acceptable functional and aesthetic results for plantar forefoot reconstruction in diabetes patients.

Using DIRECT Wound Assessment to Predict Limb Salvage and Provide Prognosis of Diabetic Foot Ulcers

전동근,권용석,배재현,이명철,Jee Nam Kim,Hyun Gon Choi,Dong Hyeok Shin 대한창상학회 2021 Journal of Wound Management and Research Vol.17 No.1

Background: Many wound assessment systems including the Wagner classification and University of Texas (UT) grading system have been previously described. The authors of this study applied the DIRECT (Debridement of necrosis, Infection control, Revascularization, Exudate control, Chronicity, and Top surface) wound coding system for initial assessment of diabetic foot ulcers (DFUs) to predict limb salvage and prognosis. Methods: From January 2016 to February 2020, a total of 169 first-time DFU patients were retrospectively evaluated using the DIRECT wound coding assessment system. DFUs were followed up for at least 6 months, and scores in each component of the coding system according to final limb status were statistically evaluated. The coding assessment’s ability to predict major amputation was compared to those of the Wagner classification and the UT grading system. Results: Subjects were divided into complete healing (n=80, 47.3%), not healed (n=71, 42%), and amputation (n=18, 10.7%) groups. The mean values of each component of DIRECT assessment for the complete healing/amputation groups were D 0.86/1.56 (P<0.001), I 0.46/0.89 (P=0.001), R 0.65/0.94 (P=0.014), E 1.15/1.56 (P=0.049), C 0.69/0.89 (P=0.086), T 0.53/0.72 (P=0.13) and the sum was 3.140/4.741 (P<0.001). The area under the receiver operating characteristic curve of the DIRECT, Wagner, and UT grading systems was 0.722, 0.603, and 0.663, respectively. Conclusion: The DIRECT coding system shows a greater association with prediction of amputation or complete healing, compared with the Wagner and UT wound classification systems. This more accurate wound assessment system will be helpful in predicting prognosis and planning treatments.

Analysis of Factors Affecting the Outcome of Flap Reconstruction for Pressure Ulcers

Dong Hwan Lee,김민지,한형민 대한창상학회 2021 Journal of Wound Management and Research Vol.17 No.1

Background: Pressure ulcers are a common and challenging problem affecting bed-ridden patients. Flap operations are considered a surgical option for treating pressure sores despite their high rate of complications and recurrence. Hypothesizing that certain factors would affect postoperative outcomes for pressure sore patients, we analyzed the factors and outcomes. Methods: We collected cases retrospectively from January 2010 to January 2018. The subjects were 95 patients who had undergone flap operation in our institution. Patient demographics, wound characteristics, and outcomes including relapses, flap complications, reoperation, and newly developed sores were analyzed. Logistic regression analysis was used to identify the association between variables and surgical outcomes. Results: Patients who had larger area of defects after debridement had more flap complications (P=0.01) and were more likely to undergo reoperation (P=0.03). Smokers (P=0.04) and patients whose wound cultures were positive (P=0.04) had more flap complications. Patients who had paralysis were more likely to require reoperation (P=0.02) and to develop new sores (P=0.02). Conclusion: We identified factors affecting postoperative outcomes after flap operation to cover pressure sores. As a more comprehensive preoperative risk assessment on flap reconstruction for pressure sores can improve outcomes, these indicators should be carefully considered when determining surgical options.

Comparing Outcomes of Single Versus Double Venous Anastomosis in Free Flap Operation for Lower Extremity Defect Reconstruction: A Meta-Analysis

김수환,이경태 대한창상학회 2021 Journal of Wound Management and Research Vol.17 No.1

Background: Free flap operation is a common procedure for reconstructing defects of the lower extremity. However, venous congestion often results in flap failure in lower extremity reconstruction. Dual-vein anastomosis, one proposed solution to overcome this problem, has been controversial in terms of its efficacy. The objective of this study was to perform a systematic review and meta-analysis to assess the effectiveness of dual venous anastomosis on venous congestion and flap failure of the lower extremities. Methods: PubMed/MEDLINE, Google Scholar base, and Embase were searched to identify relevant studies presenting complication rates for groups of patients who had undergone single venous or dual venous anastomosis in lower extremity reconstructions. The relative risks of the following complications between these two groups (single venous and dual venous anastomosis) were calculated: flap failure, flap necrosis, flap congestion, and take-back to operating room. Results: A total of eight articles and 1,434 flaps were included. Double venous anastomosis was performed for 607 flaps, and single anastomosis for 827 flaps. Etiologies of defects and types of flaps were diverse. There was no significant difference in venous congestion, flap necrosis, or flap failure between the groups with one versus two vein anastomoses. However, the dual venous anastomosis group displayed a trend toward decreasing flap-related complications. Conclusion: Although there was a trend toward decreasing flap-related complications in the double venous anastomosis group, dual venous anastomosis had no statistically significant protective effects in decreasing free flap failure in the leg.

Sensate Neurovascular Island Flap for Thumb Reconstruction

전성미,김승민,권성택 대한창상학회 2021 Journal of Wound Management and Research Vol.17 No.1

Thumb pulp defects require adequate reconstruction for satisfactory sensate function and aesthetic appearance. We report a reconstructive case using a sensate neurovascular island flap raised from the ulnar side of the middle finger for a tactile thumb pad defect. The flap was elevated as a modified version of the conventional heterodigital neurovascular island flap in order to restore thumb sensation without the “double-sensibility” phenomenon. The ulnar digital nerve of the flap was sectioned at the middle phalanx level of the donor digit and coaptated to the ulnar and radial digital nerves of the thumb through end-to-side and end-to-end neurorrhaphy. The remaining radial digital nerve of the donor finger was preserved, and the proximal end of the sectioned nerve was coaptated end-to-side to the radial digital nerve to prevent neuroma formation. No postoperative complications including venous congestion were observed. This technique is a relatively simple and reliable option for reconstructing thump pulp defects.

Tubed-Groin Flap for Coverage of Deep Burn Injuries in Two Adjacent Fingers: A Case Report

천재영,Lee Nae-Ho,Roh Si-Gyun,Shin Jin Yong 대한창상학회 2022 Journal of Wound Management and Research Vol.18 No.2

The reconstruction of two adjacent fingers is challenging for reconstructive surgeons, especially if there is a circumferential skin and soft-tissue loss along with bone exposure. Herein, we present the case of a 22-year-old male with a circumferential defect in two adjacent fingers due to an electrical burn. The patient had a circumferential soft-tissue defect with middle phalangeal bone exposure in the left index and middle fingers, revealed after serial debridement and ostectomy. After failure of free flap reconstruction, other options were considered, and the defects were repaired using a newly designed tubed-groin flap. Afterwards, flap detachment was performed on postoperative day 21 and provisional syndactyly separation without a skin graft was performed 2 weeks after flap detachment surgery. The patient was satisfied with the well-reconstructed fingers, which demonstrated adequate length and function. A full range of motion of the metacarpophalangeal joint was restored. The newly designed tubed-groin flap can be an efficient method to easily and effectively reconstruct a circumferential defect in two adjacent fingers.

The Utility of Novel Fish-Skin Derived Acellular Dermal Matrix (Kerecis) as a Wound Dressing Material

Tae Hyung Kim,박준호,정현교,위서영 대한창상학회 2021 Journal of Wound Management and Research Vol.17 No.1

Background: The newly-approved Kerecis is a piscine acellular dermal xenograft. This piscine acellular dermal matrix (ADM) has specific bioactive lipid mediators, omega-3 polyunsaturated fatty acids, and has a positive effect on the process of wound healing. This study aimed to explore the utility of this novel material by comparing healing rates, and suggest the proper timing for applying Kerecis. Methods: Patients who visited the hospital with acute or chronic deep dermal wounds from June 2019 to May 2020 were enrolled in the study. A total of 48 patients were assessed. All wounds in the experimental group (n=16) were treated only once with Kerecis and a non-adherent absorptive foam material (Therasorb) to cover the ADM. In the control group, daily conventional dressings were provided. All wounds sizes were measured with mass-market computer software in a method suggested by the authors for the first time. Results: The mean healing rate proved to be faster in the Kerecis group (P<0.05) versus the control group, and no complications were observed. It was statistically proved that treating burn wounds with the ADM showed better healing rates than the conventional method (P<0.05). Conclusion: This study establishes that managing wounds with the ADM is likely to heal wounds faster than traditional dressings. In addition, for burn wounds, a prolonged application (10 days vs. 5 days after the onset) showed a better wound healing rate (98.8%±2.5% vs. 67.0%±14.3%, respectively, P=0.029).