Chapters Transcript Complex Limb Salvage with Dr. Charlie Cheng Dr. Cheng, a vascular surgeon, describes is his use of PuraPly AM in a complex limb salvage case. Hi, I am Charlie Chang, a vascular surgeon in Houston, Texas. My interest is in surgical treatment of lower extremity arterial disease and limb salvage. I did my fellowship in vascular surgery at Baylor College of Medicine and uh I have years of uh uh practice in um vascular surgery and wound care. The first patient is a 60 year old male patient with history of smoking and hypertension. He first came to us in January of 2020 with a arterial wound on top of his left foot, arterial duplex show arterial occlusion. So we took him back for arteriogram and open up the circulation with stenting. He didn't come for follow up and did not show up until almost a year and a half later in August of 2021 he presented to the er, with acute limb ischemia. His foot was numb and he was in pain, foot was cold. The wounds from January of 2020 had gotten larger. So we took him to the or for revascularization, we opened up the clotted stent, restore the blood flow to his foot because of acute limiting ischemia. He was at risk for uh reperfusion syndrome or compartment syndrome. So he underwent fasciotomy because of his large wound on top of his foot and also dead muscle in the fasciotomy wound, he was at risk for limb limb loss. So first week of September, we took him back to the or for debris. The picture on the left, you can see uh the large wound on top of its foot with necrotic tissue and to the right side of the picture, you can see dead muscles in the lateral fasciotomy wound. For that later fasciotomy wound, we had to dere dere all of the muscles in the interior compartment. After debris, you can see a large wound uh defect on top of the foot. After debris, you can see tendons. So we apply pure apply AM to all the wounds. The lateral fasciotomy media fasciotomy and the top of the foot wound. The dimensions are listed up here and the wounds are fairly large. And the picture on the right at the bottom of the screen, you can see this is the application of P apply AM and after coverage with a non a hesive um uh dressing because of the dirty wound and possible uh more dead muscle. We took him back a week later. After a week, we were surprised at how much the wound had healed. The lateral wound has gotten smaller and there's also granulation tissue on top of the foot wound, about half of the tendons on the top of the foot have granulation tissue coverage because the wound was clean and healing. We decided to wait for two weeks. After two weeks, you can see the wounds continue to heal. The lateral wound continues to get smaller as well as the top of the foot. On October 22nd, third week of October, we noticed that the wound had um, uh dusky color. We actually, this actually had dusky color the week prior the second week of October. And so because of the dus duskiness, which came back a week later for arteriogram, reined the um instant risk nosis and restore blood flow. And then we apply pure applied. Once again in November, we took him back for another washout and p apply application. And after revascularization, you can see that the wound had pinked up on top of his foot. We will come back in December as you can see, uh the wounds continued to heal. And by mid December, the lateral wound had completely healed. And then on top of the third, we uh made our last purely application in January of 2022. And in summary, he underwent wash out and p apply application almost every two weeks. The media fasciotomy wound received four applications and closed on October 22nd. The lateral fasciotomy wound received seven applications and closed on December 15th. The arterial wound on top of his foot received nine applications. The last one being January 10th of 2022. The patient did not want to go back for more wash out and p apply application. And so he just received local wound care, but we follow him up in clinic to make sure the wound is healing and the wound finally healed on Jan on June 1st. So you're right, you can see the pictures of the lateral fasciotomy wound that's healed. The lower picture is the medial fasciotomy wound. And here you can see the foot when being healed in June. So in summary, we were able to do limb salvage on this patient with complex wound who might have otherwise received a major amputation. Published December 21, 2023 Created by
