Chapters Transcript PuraPly AM and PuraPly MZ Surgical Application by Ravi Kapadia, MD Dr. Kapadia, General Surgeon, applies PuraPly AM and PuraPly MZ following the surgical debridement of a diabetic foot ulcer. Good morning, everyone. My name is Doctor Katti. I'm a board certified general surgeon and today we have a pleasant 58 year old uncontrolled diabetic male who presents with a diabetic foot ulcer that's been uncontrolled and progressively gotten worse. He was admitted for IV antibiotics. And today, our goal is to Debre all the devi skin and soft tissue on the base of his foot. And then we will be applying both pure ply MZ and purely AM. All right. So here's the base of his right foot. All right. So as you can see here, what started as a small defect in a callous. Now, we have a pretty sizable defect and the goal was to remove all the devitalized skin and soft tissue down to the muscle and bone. We took some of the bone. So here we are just, we're just measuring the wound measures about 4.5 by four, 5.5. So now we're gonna do is we're gonna first start off by applying purify MZ, which is micro nice collagen. And then what we'll do is we'll then apply purify. Am. The reason I use both of them is because synergistically, the outcomes are just better and remember purely AM has PHMB which has a sustained antimicrobial effect um and also prevents biofilm formation, which is usually the culprit for most of these chronic wounds. This is 1000 mg of pure PLY MZ. You can apply this as a powder but because it's on the base of the foot, I like to make this into a paste. Typically the ratio is about 4 to 1. And now we're gonna do is we're just going to mix this with some saline to create a nice little paste and see the frayer and we're just applying it here and it will stick very nicely in the wind bed. And I'm gonna use all 1000 mg of it. And the good thing is by making it in a paste, we minimize wastage because it sticks very nicely. And I'm just using a freer to let this stick. It's sort of like a little spoon and there you go. So the first part is complete and now we're gonna do is we're gonna buttress this with purely, am there you go. Good job. Ideally, when we apply, this is slightly fenestrated. As you can see, we want to get good coverage of all the edges. So I'm just gonna trim it just a little bit. Now, there's multiple ways to fixate this graft. You can use steri strips, you can use Dermabond or today what we're gonna use because it's the foot and I don't want it to move is we're gonna use suture and I use a foro chromic suture. This is a dissolving suture and we're gonna anchor it in four corners. Yeah. Just hold right there. Good. You have scissors in your hand and scissors place or just cut. Yeah. Little tail. And these will dissolve in probably about a week or so. What I'll do now is I'm just gonna trim some of this excess now that it's secured on in one week. Um When I change the dressing, we'll re Debre him and see where we are with the wound. And now we do, as you can see, graft is secured circumferentially. Now we put a primary gauze dressing. I use adaptic with a little bit of hydrogel with some hydrogel, keeps it moist. And all we do is we just sort of secure this with some steri strips just so it doesn't move. This is our primary dressing, right? And our goal is to just pad the 4 ft. And then what we'll do is we'll get him fitted for a diabetic offloading shoe because we want him to offload the pressure from the 4 ft. So heels and some of the principles of wound healing are not just is multifactorial. You wanna make sure that um you're not only offloading, but you have to control the source, which we did. Um And then also make sure that we have a good bridge, which is the purely am. And the MZ and then obviously he needs to follow up with his primary care doctor to have better control of his diabetes because uncontrolled diabetes does not allow these wounds to heal the way they should. Ok. And this dressing will stay on now for one week and we'll reassess him in the office and we'll see if he needs another debridement or Grafton. So Marco and I just put a sticker on with a note. So this doesn't come off for one week. It's a reminder both to the patient and the staff taking care of them. Thank you. Published January 16, 2024 Created by
