Quick Case: The Dramatic Benefit of Vacuum Therapy Treatment

By: Dr. J. Gnanaraj and Mr. Wise Jacob

Presentation

Mr. S is a known diabetic patient who came to the hospital with septicemia. He had a coronary artery bypass carried out in 2007 and noticed a non-healing wound in the left great toe in June 2015. This was the side where the vein was harvested for the bypass. He had an injury to the shin on the affected side a month later, and within a week there was swelling of the entire limb, and dark patches appeared at many places. He had a femoral angiogram elsewhere and was advised above-knee amputation, based on the findings. Since he did not want amputation, his general condition worsened, and he came with a total count of 37,000 with 92 percent neutrophils. By the time he had traveled more than 500 kilometers to reach the hospital, he was very sick.

Treatment Given

The patient was resuscitated. Amputation of the gangrenous portion of the foot was carried out quickly, under short general anesthesia. However, the entire limb was edematous and full of pus. There were areas of gangrene in the mid thigh. Vacuum therapy was started immediately to improve the general condition, as he was not fit for a major procedure. Vacuum therapy resulted in several liters of purulent output. Once the general condition of the patient improved with vacuum therapy, a radical debridement was carried out, excising all the necrotic tissue and opening the pus pockets. Now, within 3 weeks, he is ready for skin grafting in some areas.

Gangrenous portion of the foot:

During treatment:

Dr. J. Gnanaraj MS, MCh [Urology], FICS, FARSI, FIAGES is a urologist and laparoscopic surgeon trained at CMC Vellore. He has been appointed as a Professor in the Electronics and Instrumentation Engineering Department of Karunya University and is the Director of Medical Services of the charitable organization SEESHA. He has a special interest in rural surgery and has trained many surgeons in remote rural areas while working in the mission hospitals in rural India. He has helped 21 rural hospitals start minimally invasive surgeries. He has more than 150 publications in national and international journals, most of which are related to modifications necessary for rural surgical practice. He received the Barker Memorial award from the Tropical Doctor for the work regarding surgical camps in rural areas. He is also the recipient of the Innovations award of Emmanuel Hospital Association for health insurance programs in remote areas and the Antia Finseth innovation award for Single incision Gas less laparoscopic surgeries. During the past year, he has been training surgeons in innovative gas less single incision laparoscopic surgeries.

Mr. Wise Jacob is a male nurse working with SEESHA karunya Community Hospital and was trained at CMC Vellore. Mr Jacob has additional qualifications in nurse administration and computers and has a special interest in wound management.