Case studies for the treatment of post-operative wounds

Case studies

Case reports of LIGASANO® in

post-operative wounds

Case report 1 - Wound in the groin with undermining

Fig. 1 to 4 shows how a wound in the groin (state after abscess removal) with a depth of 3 cm and a wound undermining to the medial of 8 cm is provided with LIGASANO® white.

For this wound care we chose LIGASANO® white in one centimeter thickness for tamponade or wound filling. Alternatively, you can also work with the LIGASANO® white wound strip. The wound was covered with LIGASANO® white in two centimeters thickness and fixed by an elastic bandage.

After two days, LIGASANO® was changed to white because the absorption capacity was exhausted. LIGASANO® white can be removed from the wound atraumatically and without pain (Fig. 5).

Case report 2 - abdominal, postoperative wound

The therapeutic effect of LIGASANO® white was particularly evident in the treatment of abdominal, postoperative wound healing disorders. LIGASANO® white was changed daily in the secretion phase until the wound bed was clean and granulated. In the second wound healing phase, the dressing was changed every two days. Care had to be taken that there was no adhesion between dressing and newly formed tissue.

From Fig. 1 to Fig. 3, three weeks have passed. In addition to the LIGASANO® white wound therapy, the wound margins were adapted in the granulation phase with Steristrips to further reduce the wound and to achieve a good cosmetic result.

Case report 3: Wound treatment with LIGASANO® in postoperative wound

Patient data and anamnesis:

45 years, female, three small children, geriatric nurse and farmer. Weight 104 kg with a size of 1.68 m. At the end of January 2016, she pinched her stomach on the zipper of her pants and became infected with a bird germ. Within three days the belly was already crimson, the patient got fever and pain and drove to a nearby hospital. They immediately transfered them to a large clinic in the neighboring village. She had acute kidney failure, high fever and was now hardly responsive. That same night, the toxic tissue was removed (a total of 7.5 kg!). In the intensive care unit, she was only provided with pain medication, was responsive, not ventilated, and had dialysis and antibiotics. The wound was kept open with sterile surgical drapes.

Beginning of wound treatment with LIGASANO® white sterile on 04.02.2016.

LIGASANO® white, sterile, 100 x 80 x 1 cm was inserted once a day. After three weeks, a partial closure was already achieved. The rest were treated with negative pressure therapy, a total of seven intervals of three days each. In early April, the remaining wound was closed with split skin removal from the thigh. The patient was released in mid-April. Daily check by the family doctor. Her general condition and her mental state recovered amazingly well. The split skin on the thigh is also healed very well.

The patient is currently no longer under medical treatment. By re-gaining weight, the cosmetic result of wound healing is not quite as satisfactory as expected.

Author: Raphaela Hacker, Nursing Therapist Wound ICW, Hospital Traunstein

Download full case report: Wound treatment with LIGASANO® in postoperative wounds (1.5 MiB)

Case report 4: Wound treatment with LIGASANO® white on the ankle joint

Patient data and anamnesis:

53 years, male

Hereditary polyneuropathy
State after brain tumor since the age of 40
Ankle fracture 5 years ago; Joint had to be stiffened
Alcohol and nicotine abuse

With 50 years occurring ankle pain. Swelling and water retention. The family doctor referred him to the orthopedist. First, bandages, insoles and shoe supply for stabilization. Diagnosis: Arthrosis in the upper ankle.

One year later surgery in the hospital. Stiffening of the upper ankle, again orthopedic shoe, pain and swelling continued. Change from the specialist, doubts about the supply.

Performing stiffening of the upper and lower ankle, shortening the fibula by 15 cm to allow the bone material to connect to the forefoot.

Stabilization plate installed. The operation took place in 2015. Placement of a lying plaster for two months. Load with 20 kg with increase to 40 kg in the following two months. Early 2016 Adaptation of a VACO PED shoe for further relief, beginning of a wound situation due to pressure of the shoe in the scar area without pain perception. Wound healing was abducted for several months.

In February 2017, a new wound smear showed a significant germ attack. This was followed twice by the installation of a VAC. In March 2017, she was transferred to BG Unfallklinik Murnau with suspected acute sepsis. After positive wound smear, a high level of antibiosis was given over 6 weeks.

Fig. 1: In 2015 stiffening of the upper and lower ankle, reduction of the fibula by 15 cm, to connect with the bone material with the forefoot. Installation of a stabilization plate.

Fig. 2: In April 2017 attachment of an external fixator (stabilization of the ankle with tibia and heel bone). Discharge after 6 weeks, partial load of the heel allowed (crutches).

Fig. 3: In June 2017, a 3D CT with germ imaging was performed: disintegration of the fibula, upper and lower ankle gastric. Pain therapy despite polyneuropathy (high-dose morphine).

Fig. 4: July 2017: Inoculation sites are inflamed (material reaction). Supply with LIGASANO® white slit compresses. Pressure relief with customized compression..

Fig. 5: 17.07.2017 The dressing was changed every two days.

Fig. 6: 17.07.2018 Sterile slit compresses made of LIGASANO® white were used as primary dressing.

Fig. 7: 17.07.2017: Secondary dressing and padding with LIGASANO® white.

Fig. 8: 17.07.2017 Due to the permitted heel load we padded with LIGASANO® white and green for pressure relief. At the same time fix a defect on the lower bale.

Fig. 9: 17.07.2018 Customization of a compression bandage.

Fig. 10: In January 2018 decrease of external fixator. For the next six weeks a partial load of a maximum of 20 kg is allowed.

Fig. 11: Part load afterwards with 40 kg. From June 2018 full load on the heel bone allowed. A full load on the entire foot will only be possible in a few years.

Fig. 12: Supply with a special shoe, 2-fold. Crutch supply. Care and care is provided by the wife. Patient is in early retirement, currently care level 3.

Authors:
Caritas Sozialstation Berchtesgadener Land, Wound Team Christine Kantsperger, Martina Vogel, Dr. med. med. Rudolf Bauer, Siegsdorf, specialist in general medicine

Download full case report: Wound treatment with LIGASANO® white on the ankle joint (1.0 MiB)

Case report 5: Wound treatment after surgery with LIGASANO® white

Patient data and anamnesis:

29-year-old patient, male

Main diagnosis: Wound healing after surgery in the lower abdomen, middle abdomen and upper abdomen on the left side. Secondary diagnosis: obesity permagna (BMI 45), condition after acute renal failure due to metabolic acidosis.

Course: In September 2017, a lapraskopical surgical treatment of an umbilical hernia with implantation of a ventralight mesh was performed. Abdominal pain occurred in the postoperative course. Fibrinous 4-quadrant peritonitis in ileum perforation. There was an ileal segment resection and the explantation of the ventralight network with lavage and the closure of the umbilical hernia, as well as an antibiotic therapy with Tazobac.

Pre-treatment in the clinic and home care prescribed by the family doctor: Wound cleaning with NaCl 0.9% and showering out the wound. The wound filler used was a gelling cellulose ethylsulfonate fiber with silver, and the wound was covered with an absorbent dressing. For fixing, a polyester fleece coated with polyacrylate adhesive was used. The dressing changes took place every two days through the nursing service.

The patient presented for the first time in October 2017 in our wound center, with moderate to severe pain NRS 7/8 around the wound. The analgesia was carried out with opioids 1-0-1 and if necessary, the requirement amount was increased up to 3 times a day. The wound environment was swollen and tense. The wound depth of the ulcerations in the area of the lower abdomen was 7 cm, middle abdomen 8 cm, upper abdomen 7 cm. In the wound area, a light pink granulating tissue was usually seen. The wound bed showed tight fibrin coatings. When the dressing was removed, a wound odor could be perceived. As a result of the severe, viscous and cloudy exudation, the dressing was depleted and the exudate leakage exacerbated pain around the wound environment, affecting quality of life, according to the patient.

The swelling of the cellulose fiber caused the patient to feel pressure and pain in the wound. The cellulose fiber was unable to take up due to the consistency of the wound exudate and was located outside of the wound base in the area of the wound environment. Exudation congestion inhibited granulation tissue growth.

Local therapeutic wound treatment in the wound center:

Wound cleaning: Wet-dry phase with a wound cleaning solution based on a singlet oxygen with seawater.

Wound filler: Tamponade with LIGASANO® wound strip 300 x 2.5 x 0.4 cm, white, sterile, moistened with the wound cleaning solution.

Wound coverage: superabsorbent. Fixation by means of a polyester fleece coated with polyacrylate adhesive. Dressing frequency was daily by the nursing service.

As part of the patient / relatives' education, attention was drawn to sanitary measures to reduce germs and reduce the risk of infection, daily wearing of the prescribed abdominal gland to reduce existing edema, swelling and tension of the wound environment, taking pain medication and nutritional supplements to accelerate wound healing.

Fig. 1: 19.10.2017 Lower abdomen and middle abdomen after wound cleaning.

Fig. 2: 19.10.2017 upper abdomen left after wound cleaning.

Fig. 3: 19.10.2017 Wound cleaning: wet-dry phase with wound cleaning solution soaked ES-compresses.

Fig. 4: 19.10.2017 Tamponating the sterile LIGASANO® wound strip 300 x 2.5 x 0.4 cm, white, moisturizes with wound cleaning solution.

Fig. 5: 24.10.2017 Lower abdomen depth 7 cm.

Fig. 6: 09.11.2017 Lower abdomen depth 4 cm.

Due to the mechanical stimulus of the LIGASANO® wound strip, the fibrin coatings were dissolved with simultaneous visible contraction of the wound. A promotion and stabilization of the granulation tissue until complete epithelization could be achieved.

Fig. 8: Lower abdomen after dressing removal: Vertical diffusion of the exudate by LIGASANO®.

Fig. 9: Lower abdomen after dressing removal: Recognizable structure and pore opening of the wound dressing LIGASANO®.

Fig. 10: 24.10.2017 Middle abdomen depth 7 cm

Fig. 11: 09.11.2017 Middle abdomen depth 3 cm

Fig. 12: 22.01.2018 Middle abdomen wound closure

Excess exudate in the wound is absorbed by LIGASANO® without causing dehydration. A moist, warm wound environment is promoted. An attachment with the wound bed does not take place. The foamed polyurethane foam dressing has a high suction volume without changing the size and without hardening. Skin or wound contact improves blood circulation and positively affects scar formation in terms of appearance and functionality.

Fig. 15: 13.12.2017 upper abdominal wound closure

Summary / Conclusion:

LIGASANO® shows a very good adaptation to the wound contours, without exerting pressure on the wound and the wound bed. The granulation, as well as the wound contraction occurred very rapidly with a simultaneous decrease in exudation and significant pain reduction. The decrease in the odor was achieved by the LIGASANO® used, moistened with the wound cleaning solution.

Author: Heidi Jodl, nurse, AZWM®, head WZ®-WundZentrum Augsburg

Download full case report: Wound treatment after surgery with LIGASANO® white (620.9 KiB)

Case report 6: Wound treatment of a postoperative wound with LIGASANO®

Patient data and anamnesis:

70-year-old woman with insulin-dependent diabetes mellitus, bilateral Charcot's foot. Recurrent wounds over the years (malum perforans and ulcus cruris venosum).

On 05.08.2018 discharge from the hospital after amputation of the big toe. The first dressing change took place on 07.08.2018.

Dressing arrangement of the hospital: wound cleaning with granudacyn, wound filler alginate, cover with superabsorber, as protection and fixation elastic bandage and Cellona.

From 08.08.2018 Conversion of the dressing regime: wound cleaning with LIGASANO® green, wound irrigation with granudacyn, wound filler (tamponade) LIGASANO® white (wound strip), cover with superabsorber (fleece compress with carbon filter) for odor neutralization.

All dressing changes were rinsed with Granudacyn, wound cleaning was alternated with LIGASANO® green and LIGASANO® orange. As a tamponade, LIGASANO® white was used, except in the case of wound image No. 4, since the wound was fortified with LIGASANO® green for two days.

Until 20.09.2018 the wound was cleaned with LIGASANO® orange, as a tamponade only a little LIGASANO® white was needed. The dressing change took place only every 3-4 days, the wound only secreted very weakly, wound cavity no longer present, therefore only cover with LIGASANO® white.

Wound healed on 23.10.2018. 14 days later massive hyperkeratosis on the ball of the foot, ablation by the doctor, thereby new ulcer on forefoot ball. The patient does not want to wear a relief shoe, podiatric treatment is carried out every 5-6 weeks.

Author: Manuela Estel, nurse, wound expert ICW, nursing team Waakirchen

Download full case report: wound treatment of a postoperative wound with LIGASANO® (1.8 MiB)

Case report 7: Surgical treatment of suture dehiscence with LIGASANO®

Patient data and anamnesis:

Young patient (37 years old) presents with wound healing disorder on the lower abdomen in the family doctor's office. Condition after cesarean section and several surgical procedures to condition the wound and subsequent NPWT treatment. Until now, all unsuccessful with little or no improvement in the state of the wound.

On 29.08.2017 Presentation in the family practice with remaining threads and infected joint injection port. Suture removal on 29.08.2017 by the family doctor.

Wound description: Greasy fibrinous wound bed with tendency to granulation, ample yellow-brown viscous exudate, redness around the wound, pain and offensive odor

Wound measurements: Length 1.3 Width 3.5 Depth 2.5 cm Wound bags at 3 o'clock 4.5 cm deep / 9 o'clock 2 cm deep / at 6 o'clock and 12 o'clock each 0.5 cm

Wound therapy from 29.08.2017:

Wound cleaning rinsing with NaCl 0.9%; Wound filler Tamponating LIGASANO® wound strip mini into the pockets and the wound cavity; Wound Dressing LIGASANO® 10 x 10 cm + Zetuvit plus Suction Compress 10 x 10 cm Fixation Foil Framework

Dressing change interval: once a day

The dressing changes took place in the doctor's office in intervals with the wound expert. Difficult mental condition of the patient due to the protracted wound healing disorder.

Fig. 1: Wound condition on 29.08.2017: 1.3 x 3.5 x 2.5 cm, exudation phase, moderate fibrin coatings, inflamed wound margin

Fig. 2: Wound condition on 12.09.2017: 2.0 x 0.8 x 0.8 cm, exudation phase, fibrin completely declining, wound bed clean and granulating, intact wound margin

Fig. 3: Wound condition on 19.09.2017: 2.0 x 0.8 x 0.8 cm, granulation phase, wound bed clean and granulating, intact wound margin

Fig. 4: Wound condition on 21.09.2017: 2.0 x 0.8 x 0.5 cm, granulation phase, wound bed clean and granulating, intact wound margin

Fig. 5: Wound condition on 26.09.2017: 1.4 x 0.8 x 0.5 cm, granulation phase, wound bed clean and granulating, intact wound margin

Fig. 6: Wound condition on 02.10.2017: 1.4 x 0.5 x 0.3 cm, granulation phase, wound bed clean and granulating, intact wound margin

Fig. 7: Wound condition on 10/16/2017: 1.0 x 0.4 x 0.3 cm, granulation phase, wound bed clean and granulating, intact wound margin

Fig. 8: Wound condition on 24.10.2017: 0.5 x 0.3 x 0.3 cm, epithelization phase, wound bed clean, residual defect granulating, intact wound margin

Author: Nanett Wagenknecht, nurse, nursing expert Stoma Continence Wound, pro: med Service GmbH, Dresden

Download full case report: Wundbehandlung in Nahtdehiszenz with LIGASANO® (605.1 KiB)

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