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Deep
Forehead Laceration
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Clinical
History:
MH
is an 18-year-old female who was involved in a motor vehicle accident
on October 19, 1993. There
was momentary loss of consciousness as the patient's head impacted
the front windshield resulting in deep lacerations to the forehead.
The evening of the accident the patient was taken to the
operating room for repair of the facial laceration (Photograph
#MH1).
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| The lacerations
were deep, extending down to the periosteum (outer membrane of the
bone) of the skull. All
wounds were closed with 6-0 nylon following appropriate debridement
and wound irrigation. Silverlon®
dressing therapy was initiated immediately postoperatively.
The patient spent the next five days in the hospital recovering
from the femur fracture and learning to ambulate non-weight bearing.
The Silverlon® dressing was subsequently changed daily and continued
until October 23, 1993. By the third post injury day the patient's head lacerations
were painfree. |
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Sutures were removed in the office
October 25, 1993. Eight
months after the injury photograph #MH-9 was taken.
At this time, the patient was offered further surgical
procedures to reduce the scar tissue that was present.
She refused, stating that she was pleased with the result.
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Clinical
Significance:
Lacerations
on the face, of this depth, often require subsequent plastic surgical
procedures to reduce scar tissue and improve cosmetic appearance.
With the application of Silverlon® dressing technology
in the operating room after the wound
was
sutured closed, the following benefits were noted:
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No
tattooing of the skin, as commonly seen with the application
of silver sulfadiazine (Silvadene™) cream, was present;
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Reduced
edema of the traumatized soft tissues.
Note that in areas, such as the eyelid, that
did not experience direct contact with the Silverlon®
dressing treatment, edema was present;
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No
post-operative wound infection;
- Minimal
soft tissue scar, reducing necessity for further plastic surgical
procedures.
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Full
and Partial Thickness Burn
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Clinical
History:
SB
is a two-year-old female who suffered partial and full thickness
thermal burns to her right foot and leg and right hand on July
4, 1998. According
to the mother the child fell into a camp-fire while playing.
The child was seen within 20 minutes of the time of injury
in extreme pain. Silverlon®
dressings were applied to all thermally injured areas.
Within 20 minutes the child was calm and quiet; not expressing
pain. The patient
was placed on oral antibiotics.
She followed up on July 7, 1998 for her first dressing
change. The dressings
were removed without discomfort or pain and photographs were taken.
The necrotic partial thickness skin was removed without
sedation and new Silverlon® dressings were applied.
The child followed up on July 8th, July 10th,
and July 13th, at which time the dressings were changed
and the wounds examined. After July 13th, they did all dressing changes on
a daily basis. The
child was subsequently seen on July 23rd and August
17th. Final
photographs were taken on February 23rd, 1999.
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Before
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After
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Clinical
Significance:
Partial
and full-thickness thermal burns are complex and debilitating injuries.
Silverlon® dressing therapy simplifies the daily dressing
treatment protocol. Pain
appears to be reduced within an hour after the application of the
dressing. The observed
benefits of the Silverlon® dressing are:
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Reduced
wound edema (swelling) during the first 48 hours after injury;
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Dressing
changes were done by the mother 9 days after the injury;
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Reduced
the necessity of additional wound debridement;
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Reduced
hospitalization time;
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No
requirement for skin grafting.
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Infected
Foot with Soft Tissue Loss
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Clinical
History:
JR
is a 54-year-old male who was involved in an accident with a lawnmower
on September 1, 1992. He
was seen the day of the accident at a local hospital in Asheville,
North Carolina, where he was taken to the operating room for wound
debridement (removing dead and infected tissue) and stabilization
of the open fractures of the 3rd , 4th , and
5th metatarsals
and cuboid bone of the foot.
The patient was placed on IV antibiotics post-operatively
and admitted to the hospital.
On the 4th , 5th , 6th
and 24th
of September, while in the hospital, the patient was taken
back to the operating room for further debridement of the wound.
Due to the amount of soft tissue loss and bone injury, the
patient was subsequently scheduled for a vascularized composite
graft (a graft with skin, muscle, and arterial and venous blood
supply). He was given a fifty percent chance of success, with the
possibility of amputation of the foot if the surgery failed.
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The patient was very
hesitant to go ahead with further surgery and contacted Dr. Flick's
office, requesting a second opinion.
He was initially seen October 2, 1992 in Demorest, Georgia.
(Photograph #JR-1). Silverlon® dressing therapy was initiated without further wound
debridement. The patient
was placed on oral antibiotics for 4 weeks.
On his return to the office October 19, 1992, surgical debridement
of the wound was performed: removing a portion of avascular (without
blood supply) bone and two pins that were projecting into the open
wound. The patient returned to the office November 9, 1992 The gross
infection and soft tissue swelling was resolving and the wound was
closing. No further
wound debridement was undertaken.
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| Over
the next 4 months the wound healed with the exception of a small portion
that was directly over an area of suspected osteomyelitis (bone infection).
March 31, 1993 reveals a small portion of the wound still open.
The slowness in wound healing was felt to be the result of
possible underlying osteomyelitis.
Additional bone was removed from the bottom of the lesion,
under local anesthetic in the office.
Silverlon® dressing therapy was continued by the patient.
Within 2 months, the wound was closed and skin healed (Photogaph
#JR-5).
The patient has continued to do well and has regained an excellent
range of motion of the foot, with a normal gait (walking) pattern |
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Clinical
Significance:
Despite
multiple surgical debridements, hospitalization, and appropriate
antibiotics and wound care, the patient’s wound progressively enlarged
and deepened. Once
Silverlon® dressing therapy was initiated, the wound started to
reduce in size and heal. Silver ions supplied by the Silverlon®
dressing dressings resulted in:
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Reduction in
wound edema (swelling);
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Skin with normal
sensation to light touch;
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Minimal scar
contracture and interference with mechanical foot function;
This case clearly
demonstrates the necessity for proper wound debridement.
If avascular bone is present in the wound, Silverlon® dressing
treatment will be ineffective until that portion of the bone that
is avascular is surgically removed.
In this case, once the dead bone was removed the wound healed.
Silverlon® dressing treatment will not suffice for poor surgical
technique, but will enhance wound healing once proper surgical standards
are maintained.
All dressing changes
were performed by the patient without physical therapy or nursing
assistance. A difficult
wound infection with soft tissue loss problems turned into a simple
daily dressing change performed by the patient.
With the rapid reduction in pain, the patient was able to
mobilize the foot sooner and return to normal activities of daily
living faster.
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