Most Proposed Topic :
Healthcare Advances, Research and Innovations (new projects / technology)
Proposed Topic (Second preferred): :
Enhancing Partnership with Patients and Community (Projects initiated to engage patient and improve patient communication)
Authors: (including presenting author): :
Liu KWB, Li YN, Leung LC, Lam KY, Sum WK, Chan LY, Chan CM, Leung WY, Chan YK
Affiliation: :
Department of Orthopaedics and Traumatology, North District Hospital, NTEC
Introduction: :
Standard wound care consists of debridement of non-viable tissue, infection control, proper offloading to relieve pressure and maintenance of a moist wound bed. Negative pressure wound therapy (NPWT) is widely used for wound care applications and has been specifically studied in the setting of diabetic foot wounds. Matsuzaki et al. (2016) states that advantages included the maintenance of a moist environment, easy fluid management, enhancement of granulation tissue development, enhanced local tissue perfusion and biophysical stimulation of underlying tissues to promote cellular proliferation and wound contraction. However, we were encountering poor premorbid condition. Li et al. (2023) summarized that COVID-19 can prolong wound healing by inducing excessive inflammation and oxidative stress, disturbing immune system and haematological system, as well as influencing the functions and viability of epidermal stem cells. Poor healing potential was estimated.
Objectives: :
To illustrate successful limb salvage with multimodal wound care therapies in multidisciplinary approach on young adult during COVID-19 Pandemic in Hong Kong.
Methodology: :
33 years old male with type 2 diabetes mellitus complicated with severe nephropathy and retinopathy who got COVID-19 positive and was suffering from bilateral foot wet gangrene after scald injury at home. Uncontrolled infection was found over bilateral feet plantar side while necrotic tissue extended to plantar deep compartment and heel compartment. Septic arthritis and osteomyelitis of plantar metatarsal joints were diagnosed. Patient refused bilateral below knee amputation but agreed bilateral feet debridement and ray amputation only. He was received polyacrylate pad with silver contact layer to prepare wound bed and negative pressure wound therapy to facilitate wound closure afterwards. Patient's mother was actively participating in wound care dressing at home after successfully redemostration of dressing care.
Result & Outcome: :
Wounds were completely healed after one month in patient stay as well as four months outpatient nurse wound care service follow up with caregiver engagement. Functional limb was saved. Patient walked well with heel walking sandals and stick after vigorous physiotherapy. There were no readmission and major amputation needed. In conclusion, this case study demonstrated the use of NPWT to heal a complex diabetic foot wound despite full thickness tissue loss and without the need for a more proximal amputation. Using aggressive basic wound care and the liberal use of multimodal therapies in a multidisciplinary setting, we have shown that advanced wound care methodology indeed can be successful in salvaging limbs and reducing risk of major amputation in precious OT session during pandemic. Undoubtedly, caregiver active engagement is crucial in patient healing journey.
