EXAMPLE OF NPWT IN AN ORTHOPAEDIC APPLICATION
These pictures below illustrate a very challenging case where a patient with diabetes (and vascular disease) along with a remote history of smoking was left with the forefoot below after debriding necrotic tissue removed for an infection. The patient strongly wanted to keep his foot, and avoid a below knee amputation.
The patient had an amputation at the level between the midfoot and hindfoot, which left exposed bone, but basically the surgery created a race between the ability of tissue to cover the exposed bones, vs. the exposed bones becoming necrotic. Only with the use of NPWT, which took about two months in this case, was the limb able to be salvaged.
Through the effects with NPWT of decreasing edema, contracting the wound edges, and most importantly with the negative pressure creating a gradient to bring new vascularity into the area, healing granulation tissues were able to form over the bony surfaces, and eventually, also epithelial tissue formed, yielding a foot that was able to be braced. The patient, with NPWT, was able to salvage his leg.
Another example where NPWT brought about healing:
AND EVEN ANOTHER ORTHOPAEDIC CASE SHOWING EFFECTS OF NPWT
This patient is a 72 year old male who was mauled by a pit bull. From the dog attack, the crush injury to the lower leg caused not only fractures of the fibula and tibia requiring surgery, but over the two weeks after the initial surgery, more superficial skin and muscle tissue wound up becoming necrotic (dead). After debridement, there was exposed bone, metal plate, and tendons. While the metal plate has no healing capability, and the tendons and bone have very poor circulation, with the effects of NPWT, we were able to get soft tissues to cover these structures.
Though the healing took place over several weeks, NPWT was able to induce granulation tissue to cover the exposed fibular plate, the exposed tendons, with further healing over the remaining granulation tissue and:
AVOID A BELOW KNEE AMPUTATION!!
🙂
DOCUMENTS
I have been working with Dr. Mark Brunner, DDS, who had been involved with the residency in the program in Augusta, GA, and at Marquette University in Wisconsin, who is now in private practice, and he has been considering a study about the effects of NPWT following periodontal (osseous) surgery, hoping to show a significant improvement with this additional treatment modality:
Research Grant proposed by Dr. Mark Brunner 2018
MW Patent associated with NPWT
Potential NPWT Study Proposal (written 8/12/21)
