Abstract: A chest wall defect that penetrates deep into the heart is rare, but life threatening. Reconstructing a defect such as this presents challenges regarding timing and surgical approach. The patient in the present case had a chest wall defect with an extensively encroached heart and severely impaired cardiac function as a result of radiation injury after radical mastectomy. Minimal debridement followed by a vertical rectus abdominis myocutaneous flap procedure facilitated early reconstruction that reversed the cardiac dysfunction and avoided a life-threatening situation. This experience should be beneficial to reconstructive surgeons who manage similar cases.

Abstract: A 39-year-old man with previously undiagnosed scleroderma was admitted to the UCSD Medical Center with bilateral, limb-threatening necrotic lower extremity ulcers extending to underlying fascia and muscle. Rather than amputate the extremities, the patient requested alternative treatment and underwent extensive tissue debridement followed by placement of an equine pericardium xenograft. Subsequent to treatment, the patient underwent weekly examinations and dressing changes without additional treatment. The patient was ambulating without assistance and with complete closure of a

Abstract: This report describes a case of Staphylococcus aureus osteomyelitis associated with a chronic foot ulcer that was successfully treated with surgical debridement and 6 weeks of daptomycin therapy. Daptomycin was chosen because of its excellent activity against the causative organism and the patient’s history of penicillin allergy. Its tolerability and ease of administration also facilitated long-term outpatient management. The present case provides further evidence that supports consideration of daptomycin as a treatment for S aureus osteomyelitis, especially in light of reports of

Abstract: Our knowledge about wound care has progressed considerably in recent years. Nonetheless there is a continuing need for new topical hydroactive gels in this field. Flamigel® (Flen Pharma NV, Kontich, Belgium) has recently been used on a limited number of burn patients. The hydroactive colloid gel maintains the wound in an ideal moist environment. The polymer in the tube is present in two physical forms—active and inactive. In a dry wound, the active polymer will release part of its moisture to hydrate the wound and to create and maintain a moist wound environment (“hydrogel” ef

Abstract: Treatment of necrotizing fasciitis (NF) includes radical surgical debridement often resulting in large wounds that need to be closed with methods including split-thickness skin grafts (STSG), local flaps, or guided tissue regeneration procedures. In this case report, a 45 year-old Caucasian male was surgically treated for a benign left groin hernia, developed NF, and was transferred to the authors’ burn unit. The wound was treated initially with wide debridement and with a brief delay before finally closing the wound. A collagen matrix such as Integra® Dermal Regeneration Template

Abstract: A case of infected wounds with lymphedema (non-pitting with skin changes) on the left leg showed maggots in the wounds that were covered by slough that extended under the skin edge. The patient had diabetes mellitus and hypertension (on treatment). Removal of the maggots with our routinely practiced method using turpentine oil and closed gauge dressing was tried but failed. After 3 days, closed dressing limited access dressing (LAD) technique was applied, which cleared the wound without allowing the maggots to escape from the dressing. In this case, LAD was a more controlled,

Abstract: Chronic and acute wounds with long tunneling or undermining are always a challenge to wound care providers. One of the most frequently employed treatments for closing tunneled or undermined wounds is negative pressure wound therapy (NPWT). The benefits of this treatment system are widely discussed in the professional literature, and will not be covered here. Even though NPWT allows for faster wound healing initially, in some cases, progress to wound closure is limited and healing stops after reaching a maximum potential, which may occur after just a few weeks. This adverse phe

Abstract: Background. AlloDerm® acellular dermal matrix ([ADM], Lifecell Corp, Branchburg, NJ) is gaining increasing popularity in virtually every surgical subspecialty for use in the closure of soft tissue defects, structural support, or tissue augmentation. There is limited experience in lower extremity fascial reconstruction secondary to trauma, as this can be a challenging problem for the plastic surgeon. The purpose of this case report is to demonstrate the reliability of acellular dermal matrix grafts in lower extremity fascial reconstructions. Methods. We present a patient who u

Abstract: This study evaluates the efficacy of a vacuum-assisted closure (V.A.C.® Therapy, KCI, San Antonio, Tex) device in the comparative management of clean and infected wounds. Vacuum-assisted closure was applied to 57 wounds of 51 patients. Methods. Our protocol consisted of debridement of all necrotic tissue followed by vacuum-assisted closure therapy along with appropriate antibiotic administration. In 5 cases with peripheral circulation impairment, vacuum-assisted closure therapy was terminated due to a poor tissue response. In the remaining 52 wounds, healthy granulation tissue gener

Abstract: Chronically nonhealing wounds caused by pyoderma gangrenosum (PG) are rare and often misdiagnosed. Since PG has no pathognomonic features, the diagnosis is based on clinical grounds. It is a diagnosis of exclusion and presents a considerable challenge, particularly in the absence of systemic diseases commonly associated with PG. Mistreatment or delayed proper treatment can be harmful to patients. The need to recognize trauma (pathergy) as a potential trigger of PG is important for the optimal management of these wounds. The authors present 5 patients who had PG following different fo