Chronic Refractory Osteomyelitiss

 

 
   Patient was treated at Alaska 
   Regional Hospital Comprehensive  
   Wound  Healing Center which was
   affiliated with  Praxis Clinical
   Services.

 
Chronic Refractory
Osteomyelitis
Center for Wound Healing
and Hyperbaric Medicine
240 Williamson Street, Suite 104 - Elizabeth, NJ 07207
(908) 994-5480
PATIENT:
58 year old female laundry worker with foot problems for 6 months, well-controlled NIDDM, quit smoking 6 yrs. ago.
WOUND HISTORY:
Left foot developed an infection between the first and second toes, treated with several debridements then referred to a general surgeon. Placed on IV Timentin for 6-8 weeks with worsening pain, redness & swelling.
10/99 Hospitalized
10/16/99 Surgical amputation left second toe, pathology reports osteomyelitis/early gangrene
COMPREHENSIVE WOUND HEALING CENTER MANAGEMENT:
11/12/99 TCOM demonstrates room air hypoxia, some improvement with normobaric O2 challenge. Silvadine dressing utilized.
11/15/99 Hyperbaric (HBO2) treatments (2.0 ATA x 90 min with 1-10 min airbreak protocol) begun. TCOM shows significant increase during HBO2. Patient placed on Keflex, 500mg PO tid. Wound debrided, Staph Aureus cultured.
11/18/99 Augmentin, 875mg PO bid, for wet gangrene and necrosis of interdigital spaces. Saline gauze packing for second toe and ace compression applied.
11/19/99 Transmetatarsal amputation except for great toe. HBO2 treatment continued.
11/24/99 Great toe amputated
11/27/99 HBO2 changed to refractory osteomyelitis protocol, 2.4 ATA x 90 min with 1-10 min airbreak. Iodasorb dressings utilized.
RESULTS:
Total of 40 HBO2 treatments. At follow-up appointment on 3/21/00, wound is completely healed without callus formation. Patient does not have pain, is able to walk without gait problems and is extremely pleased that we were able to save her foot.

Referral Information
Patients should be referred to the Center for Wound Healing and Hyperbaric Medicine at Trinitas Regional Medical Center for aggressive, outcome based wound management. Our center is designed to compliment the attending physician’s services by providing expert wound management consultation and care including the application of advanced wound care technology and hyperbaric oxygen treatment as indicated based on a comprehensive system of evidence based clinical practice guidelines. The referring physician will continue to treat comorbid conditions and provide for the patient’s overall medical care. Hyperbaric oxygen treatment is available specifically for the treatment of soft tissue radionecrosis, osteoradionecrosis, osteomyelitis, clostridial myonecrosis and other necrotizing soft tissue infections, compromised skin grafts and flaps, crush injuries and other acute traumatic ischemias, and diabetic wounds of the lower extremities. All etiologies of wound healing failure are accepted for evaluation and care.

Types of wounds treated include Diabetic, Venous Stasis, Ischemic, Pressure, Traumatic, Surgical and other wounds that resist healing.
Problem wound patients should be referred to the Center when:
The wound has failed to show significant progress in 4 weeks of standard care
When the wound involves deep tissue structures or is limb or life threatening
When the wound is complicated by significant comorbidities including peripheral
    vascular disease, persistent edema, persistent infection, prior radiation treatment
   to the area, or compromised immune status of the patient

To refer a patient, please call (908) 994-5480 or visit us at www.trinitashospital.com


 
 

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