Application in a Bilateral Heel Pressure Injury
Michael Cormican, MD
Trauma Surgeon – Northeast Georgia Physicians Group | Northeast Georgia Medical Center – Gainesville, GA
Pre-operative Assessment
Day 36
Results
- STSG applied bilaterally
- ~75% STSG of the left foot and ~80% take of the right at 1 week
- No infection or device-related complications
Patient details
58-year-old male
Medical history
High BMI, uncontrolled diabetes, atrial fibrillation
Case details
- Description: Full thickness heel pressure injury with exposed bone, tendon and necrotic tissue
- Found unresponsive in his car for indeterminate amount of time, soaked in rainwater and feces
- Approximate Size: Left, 11 x 8 cm; right, 15 x 9 cm
Application photos
Pre-operative Assessment
- Full thickness injuries with a high degree of contamination
- Both defects required aggressive debridement of non-viable tissue
Week 0
- Procedure: Debridement, antibiotics and partial calcanectomy to both extremities
- Applied Myriad Morcells (2 x 1000 mg, to each defect) plus Xeroform® to both index defects and ancillary ulcerations of the left plantar foot
- Secondary dressing: NPWT at 125 mmHg
Day 12
- Noted buds of granulation as Myriad integrates
- Allow time for granulation to build and bone to demarcate for possible further resection
- No complications
Day 15
- Procedure: Additional debridement of soft tissue and bone
- Reapplied Myriad Morcells (2 x 1000 mg, to each defect)
- Secondary dressing: Xeroform® and NPWT at 125 mmHg
Day 21
- Continued development of vascularized granulation tissue
- No complications
Day 32
- Full coverage of bone and tendon
- Vascularized, granular neodermis formed
- No complications
- Ready for split-thickness skin graft (STSG)
Day 36
- STSG applied bilaterally
- ~75% STSG of the left foot and ~80% take of the right at 1 week (Note: reduced STSG take likely due to patient ambulating against medical advice).
- No infection nor device-related complications
Results may vary. Dr. Cormican has a consultancy agreement with Aroa Biosurgery Limited.
Xeroform® is a trademark and property of the respective owner.
