DOI: 8/27/2014. The patient is a 45-year-old male laborer who sustained a work-related injury when he stepped on a sharp foreign object which pierced his skin. As per OMNI, he was diagnosed with open wound on the foot. The patient underwent a right foot surgery with bilobed rotational skin flap of the foot, debridement, harvesting of a full thickness skin graft at a separate site and application of a full thickness skin graft per operative report dated 5/29/15. Based on progress report dated 06/22/15 by Dr. Wrotslavsky, the patient is 3 weeks status post skin flap and skin graft right plantar foot. Patient states he cannot reach his foot and do his own dressing changes. Patient has a right foot ulcer. He states Methicillin-resistant Staphylococcus
Shortly the incision made off the weight bearing surface of the posterior heel. Guide wire from the 70 cannulated
I was just two weeks into my internal medicine rotation at Suez Canal University in Egypt, when I encountered a case that I still remember to this day. Ms. Rafat was an elderly diabetic patient that came into our clinic complaining of a persistent wound on the sole of her foot. Upon removing her boots, her complaint turned out to be a foot ulcer with an infection extending to the first and second metatarsal bones .Unfortunately for her, we had to break the news to her and her family that her foot would need amputation. Ms. Rafat was understandably upset but took the news in stride. Following up on her case, I learned that after the surgery, the blood flow to her leg became increasingly poor and she had to return to have a below the knee amputation. Ms. Rafat ended up dying of pulmonary embolism as a complication of her second surgery. This case stayed with me not only because it
HISTORY AND PHYSICAL EXAMINATION_______________________ Patient Name: Chapman Robert Kinsey Patient ID: 110589 Room No.: 322-B Date of Admission: 23 February ---Admitting Physician: Martha C. Eaton, MD, Geriatrics Chief Complaint: Admitted from Dr. Max Hirsch’s office due to deep ulcer on left toe. Admitting Diagnoses 1. Severe peripheral vascular disease, status post deep ulcer on left toe. Rule out thrombolysis. The patient was admitted to a regular floor. Condition is serious. 2. ALLERGY TO PENICILLIN, which puts patient into anaphylactic shock. 3. Continue with home medications. DETAILS OF PRESENT ILLNESS: Mr. Kinsey is an 87-year-old white gentleman with history of (1) Chronic atrial fibrillation, on Coumadin. (2) Chronic deafness,
PHYSICAL EXAMINATION: HEENT: Tympanic membranes and external auditory canals are within normal limits. Throat is clear with no gingival lesions. He is ______________. No obvious proliferate retinopoathy. NECK: No carotid bruit. No thyroid enlargement. LUNGS: Clear to auscultation. HEART: No S3, S4 or murmurs. ABDOMEN: Soft with no organomegaly. Normal bowel sounds. FEET: Good dorsalis and posterior tibial pulses bilaterally. Left foot has no abrasions, lesions, sores or ulcers. Right foot shows obvious deformity from previous break. He has an area located between his second and third metatarsal head that has clearly been an abscess that has broken through. He also has an obvious foot ulcer located over the instep of his right foot, full thickness. There is tracking to the broken foot, to which the ulcer area is connected and there is a question of osteomyelitis in this area.
Why was skin-grafting necessary in this patient? (why not just let the skin heal on its own)
Department of Orthopedic Surgery, The First Affiliated Hospital, 3Department of Pharmacy, Dalian Medical University, and 2Institute of Reconstructive Surgery, Dalian University, Dalian, China
Based on the progress report dated 03/28/16 by Dr. Bakhos, the patient presents for follow-up of his right knee
Aniya presented to Children’s Hospital Emergency department on 8/4/2017 as a level II trauma after she had been reportedly hit by a train. Per EMS Aniya was attempting to jump on the train and fell and the train “ran over” her R leg, where there was a deep leg laceration below the knee. She was admitted to the hospital. She was taken to the OR for irrigation and debridement of the right knee joint and right knee would as well as VAC-assisted closure of right knee wound. She was taken back to the OR on 8/6/17 for another irrigation, debridement and VAC change. On 8/8/17 she was taken to the OR again and diagnosed with complex degloving injury of the right medial knee region. She received skin grafting to the tight lower extremity and application
His dressings are removed along with the brace and his incision is a curvilinear laceration through the medial retinacular region. Extensor mechanism of the knee is intact and a straight leg raise is painful but normal. Range of motion is grossly limited in flexion secondary to pain but full extension is easily achieved. He is stable with varus and valgus stress testing at 0 and 30 degrees. Gentle Lachman's test does not demonstrate any gross instability. The ankle shows some dependent edema but no acute injury. Range of motion, dorsiflexion, plantar flexion, inversion, and eversion are all intact with adequate strength. Extensor hallucis longus, dorsiflexion, plantar flexion function of the ankle are all intact with 5/5 strength, L3-S1 sensory dermatomes are intact to light touch, though the patient does describe some mild periwound numbness. There is no streaking erythema. Wound is benign and shows no signs or symptoms of infection. Vascular tone is full and compartments are
Throughout the procedure, I was able to interact with the patient and communicate effectively with him, discussing his pertinent health history as well as his experience in dealing with his chronic wound. Such communication and patient interactions bring an abundance of positive feelings to any clinical situation. I also felt positively about the decision of the nurse and healthcare provider in the use of barrier cream to prevent further maceration of the peri-wound skin,
11/18/15 Progress Report documented a follow-up visit. The patient presented with a history of right knee pain, stating the current level of pain is a 5/10. On exam, the physician indicated the patient had a tentative gait with ecchymosis to the right lower extremity. The patient had a 20 cc effusion to the right knee. There was tenderness of the tibial tubercle in the medial joint line. There was also tenderness of the patellar tendon. The physician indicated that the patient is progressing in physical therapy and recommended the patient continue to regain full function of the knee.
Operation finding used to be infected unhealthy base partially ruptured appendices. Third post-operative day (POD) wound opened at some stage in surgical spherical I have considered that while opened and closed the wound sterile approach no longer followed. The one who opened the wound dressing wore unsterilized gloves and unsterile pad used to shut the wound. Before contacting the wound hand rubbing now not performed. Fifth POD Mr. Hussein experienced immoderate grade fever, severe surgical site pain due to surgical i site infection (SSI).
This surgery was performed three days following the accident, due to swelling of the affected limb.
Skin flaps are commonly used in plastic and reconstructive surgery to repair defects resulting from trauma, congenital anomalies, or after tumor resection. Partial necrosis of the flap can be encountered postoperatively as a result of inadequate blood supply (Lu et al., 2008). Subsequent management of flap necrosis usually includes time-consuming and repetitive dressing changes aimed at promoting secondary intention healing or even secondary reconstructive procedures (Lubiatowski et al., 2002).
The diabetic foot disease is the leading cause of non-traumatic lower-limb amputation and results from three common pathologies: diabetic peripheral neuropathy, peripheral arterial disease, and infection. Late complications include foot ulceration, Charcot neuroarthropathy and amputation (Turns, 2013, p.422) though another specialist like, Iraj who wrote Prevention of Diabetic Foot Ulcer, added to the most common facts: deformities and minor