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Case Report: Using Dual Therapies of a Negative Pressure Wound Therapy (NPWT) and Modified Silicone Gel Liner to Treat a Limb Postamputation and Dehiscence

Paula S. Pattison, RN, BSN, CWOCN, Caritas Holy Family Hospital and Medical Center, Program Director Wound/Ostomy/Continence Clinic, 70 East Street, Methuen, MA 01844, Jonathan K. Gordon, MD, FACS, CWS, Caritas Holy Family Hospital and Medical Center, Vascular Surgeon, Medical Director Wound Clinic, 70 East Street, Methuen, MA 01844, Paula M. Muto, MD, FACS, Caritas Holy Family Hospital and Medical Center, MD, 70 East Street, Methuen, MA 01844, John K. Mallen, MD, Caritas Holy Family Hospital and Medical Center, Plastic Surgeon, 70 East Street, Methuen, MA 01844, and Jeffrey Hoerner, PT, CPO, self employed, Private Consulting.

PURPOSE: This case study illustrates a positive outcome using dual therapy of negative pressure wound therapy (NPWT) and a modified silicone gel liner to treat a nonhealing, dehisced incision following a below-the-knee amputation. The primary goal of using the two therapies together was to reduce recuperation time by simultaneously closing the wound while actively reshaping and shrinking the limb residuum for a prothesis which in turn enhanced the patient's sense of control and self worth.

STUDY: This study illustrated that after 26 days of combination therapy with NPWT and the silicone gel liner, the wound length and width measurements had decreased by 50%, and the depth and tunneling were reduced to 0.0 cm. The wound was 100% granulated to the surface. The diameter of the residual limb was reduced from 38.5 cm to 36.0 cm, and the limb contour was reshaped from oval to cylindrical. Three days after the discontinuation of NPWT, the patient was fitted with a prosthetic leg. Prior to incorporating these dual therapies concurrently, our standard of care for a BKA wound was to apply NPWT until the wound closed and then shrink and reshape the limb residuum. This 2-step approach could take approximately 30-60 days longer.

OUTCOME: By using dual therapy NPWT and a silicone gel liner for limb reshaping and shrinkage the rehabilitation process was accelerated. Dual therapy decreased the number of days for prosthetic fitting, offered mobility and a high sense of self worth and control for the patient. This process decreased physical therapy time and the overall number of prosthetic fittings.

CONCLUSION: By using dual therapy of NPWT and a silicone gel liner for limb reshaping, recuperation time was significantly reduced. In today's world climate this is a noteworthy standard for care.


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