A Multistep Iter for Functional Reconstruction in Mangled Upper Limb: A Retrospective Analysis of Integrated Surgical and Medical Approach

Abstract

Background and objectives: Complex limb wounds with multiple tissue involvement are commonly due to high energy trauma. Tissue damage is a dynamic entity and the exact extent of the injury is rarely instantly perceptible. Hence, reconstruction frequently involves a multi-stage procedure concluding with tissue replacement. Materials and Methods: A retrospective study was conducted between 2006 and 2018 and included 179 patients with contaminated multi-tissue injuries treated with hyperbaric oxygen therapy, negative pressure therapy, physiotherapy and drug treatment associated with multiple surgical time in a multistep approach, focusing on pain levels and wound closure rates. Results: Despite the long-term response to traumatic events, a combined approach of delayed surgical reconstructive time in mangled upper limb yielded satisfactory functional outcomes. Conclusions: The complex upper limb wound with deep tissue exposure may be treated with a multi-stage procedure alternatively to immediate reconstruction. The integrated technique enables the preservation of existing healthy tissue and concurrent radical debridement, reducing the risk of infection, as well as avoiding the loss of free flaps and dehiscence due to incorrect wound estimation.

Hyaluronic Acid/Collagenase Ointment in the Treatment of Chronic Hard-to-Heal Wounds: An Observational and Retrospective Study

“…Surgical debridement is commonly used for large surface wounds that are severely infected and often require the removal of exposed infected noble structures (bones, cartilage, and tendons). This debridement is more rapid and effective compared to other complementary methods, such as VAC and OTI therapy [21,22], even though it is more invasive.…”

Contribution of Topical Agents such as Hyaluronic Acid and Silver Sulfadiazine to Wound Healing and Management of Bacterial Biofilm

“…Despite proper management of a hard-to-heal ulcer, infection of the ulcer with associated inflammation is a probable cause of delayed healing, notwithstanding the availability of a broad spectrum of antimicrobials for prophylaxis and treatment [7]. For such chronic wounds, the initial management generally involves aggressive surgical debridement, hyperbaric oxygen therapy, and vacuum therapy [2,8], but the use of topical dressings to manage biofilms and prevent inflammation progression requires further investigation.…”

Analysis of Rinsing Fluid during Negative Pressure Wound Therapy with Instillation: A Potential Monitoring Tool in Acute and Chronic Wound Treatment. A Pilot Study

“…Vacuum therapy is undoubtedly an effective tool in the treatment of acute and chronic wound conditioning [ 19 , 20 ]. However, the underlying mechanisms are not conclusively understood and clinical monitoring between dressing changes is limited.…”