Wound Case Studies

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

On 5/30/18 I met Mr. Reid at the office of Dr. Rampersaud. I explained that the insurance carrier is not getting the form filled out correctly regarding his narcotic medications. I asked his permission to meet with Dr. Rampersaud when they go back to the examination room and leave once we discussed the form. Mr. Reid agreed. He reports that since having the spinal cord stimulator battery replaced his pain is 60% better. He reports his pain level is a 6. He continues to have his legs give out unexpectable. He reports needing help from his wife to roll him over when he is in bed. He continues to use a wheelchair. Mr. Reid said he wanted to speak with Dr. Rampersaud regarding decreasing his medications at least for the summer. He feels the warm weather makes his pain more tolerable.

An attending physician statement completed by Dr. Peter Chweyah (Internal Medicine), dated 06/16/2016, indicated that the claimant presented with complaints of lower extremity weakness, neuropathy, weight loss, acute renal failure, and gout, as well as anemia. Objective findings showed an extreme weakness of the legs and pain in the feet. He also had diabetes mellitus type 2, chronic kidney disease, and hypertension. It was noted that the claimant was totally disabled from 05/30/2017 through 06/15/2017 and 05/23/2017 - 05/26/2017 secondary to gout.

DOI: 1/23/2014. This is a 36- year old male relief driver who sustained injury while he was putting away the automatic tarper when he was struck on the right shoulder and got driven into the ground and twisted his right foot. Per OMNI, he was diagnosed with right shoulder strain, and back/neck/right foot fracture. As per office notes dated 6/3/16, the patient is complaining of numbness in all extremities specifically the bilateral feet, arms and bilateral elbows. He has had a flare-up of pain that past couple of weeks around lateral column of the right foot made worse with walking and standing. He has been taking Neurontin 300 mg thrice a day which is helping control his symptoms. He apparently had a bilateral upper extremity upper extremity

During the first six sifts of my clinical practice at Eagle Ridge Hospital I provided care to a 62 year old male patient with bilateral below the knee amputation. The patient has a history of osteomyelitis related to the poorly controlled diabetes type II. The left foot was amputated two years ago. The left stump was well healed. However, the patient had been suffering from the phantom limb pain controlled by gabapentin. The right foot was amputated a month ago. The right stump was healing well. The edges of the wound were well approximated, with small amount of serous exudate. The dressing was to be changed daily as per doctor's order. The type of dressing was specified by the wound care nurse.

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.

On 6/14/16 I met Mr. Blake at the U of M wound clinic, Midland location. Mr. Blake said over the weekend, the white end cap fell off his pin to the third toe. Since that time he reports an increase in pain to that toe. Mr. Blake reported that he called Dr. Biddinger’s office and he was told to come in on 6/15/16. Dr. Taylor examined the foot. He removed some calloused skin around the toes. Dr. Taylor stated the wound is completely healed now. He does not need to come back to the wound clinic.

Client also states that her long toe" or "pointer toe" on her right foot was infected and the cut off the area that was infected is

Based on the medical report dated 04/14/16, the patient presents for medication maintenance. He reports ongoing pain, withdrawal symptoms such as increased pain,

DOI: 2/25/2014. Patient is a 23 year-old male laborer who sustained a work-related injury to his right hand index finger, middle finger, and ring finger when they got caught in the mixer paddle. As per OMNI entry, the patient underwent open reduction fixation on 3/4/2014 and another surgery for removal of pins, skin graft, and debridement on 06/2013.

DOI: 4/10/2012. Patient is a 62-year-old male customer service representative who sustained a work-related injury to his left foot and low back due to cumulative trauma from repetitive duties. Patient is diagnosed with recurrent lumbar disc herniation at L4 to L5. He is status post right L4 hemilaminectomy, L4 to L5 microdiscectomy with removal of exterior fragment on 01/08/2014. He underwent an endoscopic left plantar fascial release on 05/04/13.

It was noted that functional levels are not very well improved, however, patient is recovering from neck surgery. He has bilateral shoulder complaints which severely limits his ability to do a lot of household type chores. Despite these numbers, he will continue his same opioid medications. He is only on a low-dose opioid medication and does not want to increase

He returned to see Dr. Kahmann and underwent further diagnostic studies. Approximately eight months ago, he underwent a two-level decompression. However, about three months after that, he was taken back to surgery for redo decompression at L2-3. Currently, there is constant burning pain in his left lower extremity along with hyposthesia and weakness. He finds it difficult to sleep at night because of his pain. Lumbar spine examination revealed well-healed anterior and posterior surgical scars. Lower extremity neurological examination revealed decreased sensation in the L2, L3, L4, L5 and S1 dermatomes. There was 4+/5 to 5-/5 strength in the left peroneals and left EHL, and an absent left AJ reflex. The SLR is positive on the left. Lasegue maneuver and femoral stretch are negative. Gait is waddling. Unable to heel walk on the left. Able to toe walk with some difficulty on the left. Lumbar ROM was significantly reduced. The patient is currently

After opening wounding, the blood vessels in the wound site had spasm which caused clot to formed, after that blood vessels then dilate to allow white blood cells to move through, enzymes and nutrients to reach the wounded area. This leads to a rise in exudate levels so the surround It, erythema, heat, edema, pain and functional disturbance

Per the medical report dated 06/07/16, the patient complained of pain with a pain rating of 6/10. He states continued relief with use of his current medication regimen.