001: The Woes of Hallux Trauma Correction in the Neuropathic Uncontrolled Diabetic

Submission Category: Case Series/Study   
Submitter and Primary Author: Boyd Bills, DPM – UT Health San Antonio, Assistant Professor Orthopedics/Podiatry 

Introduction    
I present three unique cases of hallux trauma involving the interphalangeal joint.  What links the patient's together is their similar underlying conditions. All three patients have diabetic neuropathy secondary to uncontrolled diabetes mellitus. Outcomes were the same for all the patient of septic arthritis and joint destruction of the interphalangeal joint. All were treated with surgical intervention, antibiotic therapy, but in the end the hallux were stabilized and amputation was prevented.    

Discussion   
It is apparent that these open type of injuries require a longer term antibiotic therapy with higher risk of septic arthritis and osteomyelitis. Though this is a small sample size with varying types of trauma, the underlying disease systems increase the risk of infection, but a amputation can be prevented with appropriate care.

002: Use of a Novel Negative Pressure Peel and Place Dressing in Four Patients with Diabetic Foot Ulcers or Diabetic Foot Amputation Wounds  
Submission Category: Case Series/Study  
Submitter and Primary Author: Robert Klein, DPM, FACFAS, CWS – University of South Carolina School of Medicine -Greenville, SC; Prisma Health, Greenville, SC

Introduction   
Negative pressure wound therapy (NPWT) typically requires dressing changes every 2 to 3 days. A novel dressing has been developed that incorporates a fenestrated, non-adherent layer and negative pressure drape into the dressing design allowing for up to seven days of wear. Use of this peel and place dressing* in 4 patients with diabetic foot ulcers or diabetic foot amputation wounds is presented.   

Methods   
Systemic antibiotics were given as necessary. Patients underwent sharp debridement prior to application of the peel and place dressing if needed. Dressing changes occurred every 4 to 7 days. Upon dressing removal, all wounds were cleansed using a hypochlorous acid solution and gently patted dry.   

Results   
Four patients (age range 66-75 years) presented for care. Wound types included Wagner Grade 3 diabetic foot ulcers (n=2), surgical dehiscence following transmetatarsal amputation (n=1), and surgical wound after open first ray amputation (n=1). Patient comorbidities included diabetes, neuropathy, coronary heart disease, hypertension, tobacco use, and obesity. Prior treatment included traditional NPWT or use of medical honey. Prior to presentation, wounds were present from 12 to 116 days. Dressing applications were simple, taking approximately two minutes to complete. None of the patients reported any pain at dressing application or dressing change. Granulation tissue development and wound size reduction was noted in all patients. Mild periwound maceration was observed in two patients, with one due to non-compliance with offloading and diaphoresis. Mild skin irritation was observed in one patient that was resolved once the dressing size was reduced.   

Discussion  
Use of NPWT with the novel peel and place dressing for wound management resulted in increased granulation tissue development and wound size reduction in all patients. The dressing design simplified application resulting in less time needed for dressing changes. Patients did not report any pain during dressing application or removal.   

Trademarked Items   
*3M™ V.A.C.® Peel and Place Dressing with 3M™ ActiV.A.C.™ Therapy System, Solventum Corporation, Maplewood, MN   
 

003: Initial Experience with a Novel Negative Pressure Wound Therapy Peel and Place Dressing in Lower Extremity Wounds 
Submission Category: Case Series/Study 
Submitter and Primary Author: Ralph J. Napolitano, Jr., DPM, CWSP, FACFAS  – OrthoNeuro 

Introduction  
The application of negative pressure wound therapy to support healing of lower extremity wounds is well-documented.¹ A recently available multilayer peel and place dressing (MPPD)* incorporates a perforated non-adherent layer, reticulated open cell foam dressing, and a hybrid acrylic and silicone drape, which enable it to be placed over the wound and surrounding intact skin. In this case series, we report the outcomes of application of NPWT with MPPD in 4 patients with lower extremity wounds.  

Methods  
Deidentified data was collected after obtaining informed patient consent and stored in accordance with federal regulations. Patients had injuries to the foot or lower leg and received NPWT with MPPD at -125 mmHg for 10-21 days, with dressing changes conducted every 5-7 days.  

Results  
Two male and two female patients, ages 28 to 77 years old, were included in the study. Wound etiologies included surgical wounds, a traumatic injury, and a decubitus ulcer. After 10 days of therapy, the wounds showed notable improvement and there was a significant reduction of periwound edema. We observed no periwound maceration in 3 patients; in the fourth, maceration was noted at the first dressing change and resolved after negative pressure was increased to 150 mmHg.  

Discussion 
The new NPWT dressing performed as expected, removing exudate and creating an environment conducive to wound healing. Application of the MPPD dressing was quick and easy, requiring only minimal trimming or shaping of the drape.  

Trademarked Items  
*3M™ V.A.C.® Peel and Place Dressing; Solventum, Maplewood, MN  

References  
1. Capobianco CM, Zgonis T. An overview of negative pressure wound therapy for the lower extremity. Clin Podiatry Med Surg. 2009;26(4):619-631. doi:10.1016/j.cpm.2009.08.002