Chapters Transcript Fasciotomy Case Review with Dr. Charlie Cheng Dr. Cheng, a vascular surgeon, describes his use of PuraPly AM on a bilateral forearm fasciotomy 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. This is a 46 year old male patient who presented with gunshot wound to the right thigh. He had transected both femoral arteries and veins and he has significant blood loss requiring aggressive fluid resuscitation during the surgery and post op. He developed compartment syndrome because of large fluid uh requirement for resuscitation. And he required fasciotomy of both forearms and right lower extremity orthopedic surgeon took him uh to the or for bilateral form fasciotomies. The right for wound healed with skin graft, the left for wound had dead muscles and required debris leaving a large wound defect. Here, we have a picture of the left for you can see that muscle in the wound. September 2022 orthopedic surgeon took him back for debris. A month later, the wound continued to have that muscle. As you can see here, the patient actually was from out of town. So we could not uh do wash out and, and application as we would like. Uh, every couple of weeks in January of 2023. As you can see, he continued to have persistent dead muscle in the womb since I was taking care of his right thigh wound. As we'll see later, the sur surgeon told me that I can take care of this forearm wound as well. So in, in February of 2023 I derided all the dead muscle leaving a large wound defect. As you can see here for the deep wound, I apply purely MZ followed by coverage with purely AM. Here's the purely a coverage and then apply a non adhesive dressing on top of the p apply in March, you can see the wound had completely healed for the forearm wound. He received a total of two pre applied applications with uh two wound debris and washouts. Here's a picture of the right thigh of the same patient because of a compartment syndrome and poor perfusion. All the muscles in his lower leg had died. So we had to do a guillotine amputation. As you can see here, here's a trans knee amputation. Here is the lateral fasciotomy wound. Here is a me fasciae wound. What we noticed was with the bowel movement, the patient will have spillage of stool on this medial famy wound. And so we took him back for wash out and to minimize wound infection. We decided to apply pure apply AM here's the application of pure reply a followed by non a hesive coverage. The hope was to provide a antimicrobial microbial uh barrier in an area where there is stool spillage. Here is a picture of the lateral fascy wound after healing. Here's a picture of the middle fashion army wound that is healing well and here's a picture of the wound at the end of March, he received a total of four purely applications and wound washouts. This patient was from out of town and so we could not uh take him back to the or every two weeks for washout application as we would have hoped. But as you can see, even with just four wash out and pure apply application, almost once every month, we were able to get this wound to heal. Published December 21, 2023 Created by
