This is our wound page.  Links to photos showing recent wound changes below..  

Image Links

Wound 1 10 03.jpg     Wound 2 27 03.jpg     Wound 2 28 03.jpg     Wound 3 1 03.jpg     Wound 3 2 03.jpg

Wound 3 3 03.jpg     Wound 3 4 03.jpg         Wound 3 5 03.jpg         Wound 3 30 03.jpg          Wound 4 3 03.jpg 

Wound 4 12 03.jpg      Wound 4 19 03.jpg      Wound 4 26 03.jpg

Dressing:  DermaGran changed once per day   This has worked very well.  DermaGran was started on 2 21 03.  The wound appeared much better by 2 27 03, and we started taking photos.  Prior to 2 27 03, the would appeared much as it did on 1 10 03.

GENERAL NOTES:

The wound was the result of two debridments.   The initial cause may have been a brown recluse bite.  It also may have been coumadin necrosis.  The necrosis began above the knee in October, and spread below the knee by November.  The wound stabilized after coumadin was ceased.  The lower edge of the wound has been previously irradiated.  Also, papain was used in the wound while the patient was taking coumadin.  The wound worsened the following day.  According to coumadin prescribing information, papain should not be used with courmadin.

Wet to dry dressings caused too much damage to granulated tissue.

Wound VAC was used, but severe maceration resulted. And the bed of the wound turned black.  The use of the VAC was discontinued.  Wet to dry used for a while, switched to Xeroform on 1/20/03. Then switched to DermaGran on 2 21 03.  Very significant improvements in granulation, tendon appearance, and slough removal following use of DermaGran

Begain using Hydrogel Sheet dressing on 3 30 03 along with DermaGran.  Hydrogel Sheets are a Kendall product.  Wound takes 2 4x4 sheets.

Initially used an overthecounter hydrogel that was easy to work with.  The Kendall products are too thick for this wound.  The tendons are very convex and the kendall sheets will not bend on a very tight radius.  Then used the hydrogel as a secondary dressing to the DermaGran.  On 4-17 started applying a liquid hydrogel to the wound.  This allowed the hydrogel sheets to stick to the wound.  At that point, went back to hydrogel sheets.   Tendons are now mostly granulated by 4 26.

Going into the hospital on Sunday 4-27.  Surgery is Monday to rotate a calf muscle flap over the tendons and then apply a skin graft.

Final Note:  I am very sorry to report that my lovely wife passed away on 5-18-2003.  She was only 45.  The surgery to repair the wound was very successful.  The muscle flap and skin graft were 100% successful.  Unfortunately, breast cancer had rapidly worsened.  Two days following the surgery, she developed Thrombotic Thrombocytopenic Purpura.  This was likely manifesting itself prior to the surgery, but the low platelet counts were attributed to chemotherapy.  Giving platelets prior and after the surgery caused respiratory, liver, and kidney failure.  We thought that she would survive, and she briefly came off the respirator.  Only to relapse again following additional platelet administration.  The doctors never knew that TTP was the cause.  They missed it, but it would have made no difference at that point.  We tried, and that is the important thing.  She was a very special lady and I miss her so terribly much.

paulcrumpler@yahoo.com