![]() ![]() In the setting of complicated defects, point-of-care designed custom devices may be considered to maximize the preservation of surrounding vital structures while also promoting maximal wound healing. Difficulty in application of NPWT to complex facial wounds as well as the possibility of damage to the facial structures from negative pressure have limited its application to small case series in the head and neck. ![]() NPWT has been shown to have improved outcomes in certain infectious settings, and inability to use wound vac is associated with prolonged wound care, as well as significant pain from daily or even more frequent dressing changes. Between and following debridements, NF in the head and neck, as in other sites, is typically managed with either wet to dry dressings or negative pressure wound therapy (NPWT) via wound vacuum (wound vac) until the wound bed is considered sufficiently well-healed for reconstruction. ![]() ![]() In such cases, aggressive surgical debridement is still the standard of care, but is complicated by the proximity of infection to vital structures. Most patients require multiple debridements, which can result in massive defects requiring reconstruction. The disease is treated with a combination of intravenous antibiotics and aggressive surgical debridement to expose healthy, bleeding tissue. Necrotizing fasciitis (NF) is an uncommon, rapidly progressive infection of the subcutaneous tissue and superficial fascia with secondary necrosis of the overlying skin. This report also demonstrates feasibility of point-of-care manufacturing of customized devices for optimizing complex wound management in the head and neck, and describes successful use of the United States Food and Drug Administration’s Expanded Access for Medical Devices Emergency Use mechanism. Patient-specific, three-dimensional printing is an innovative solution that can facilitate safe placement of negative pressure wound therapy adjacent to delicate structures. She was eventually decannulated and at six-month follow-up has excellent wound healing and periorbital function. With continued vacuum therapy, the wound contracted to allow for safe tracheostomy placement, ventilator liberation, oral intake, and hemifacial reconstruction with a myofascial pectoralis muscle flap and a paramedian forehead flap 1 month later. As a solution, under the Food and Drug Administration’s Expanded Access for Medical Devices Emergency Use mechanism, we designed a three-dimensional printed, patient-specific silicone wound splint from a CT scan, allowing the wound vacuum to be secured to the splint rather than the eyelid.Īfter 5 days of splint-assisted vacuum therapy, the wound bed stabilized with no residual purulence and developed healthy granulation tissue, without injury to the eye or lower lid. A negative pressure wound vacuum was considered for improved healing, but proximity to the eye raised concern for vision loss due to traction injury. After multiple debridements, she remained critically ill with poor vascularity of tissue in the wound bed and no evidence of healthy granulation tissue and concern for additional breakdown towards the right orbit, mediastinum, and pretracheal soft tissues, precluding tracheostomy placement despite prolonged intubation. Case presentationĪ 58-year-old female presented with necrotizing fasciitis of the neck and hemiface. We also describe the process and implementation of the United States Food and Drug Administration Expanded Access for Medical Devices Emergency Use mechanism. We present a case in which a patient-specific wound splint was manufactured using computer assisted design and three-dimensional printing at the point-of-care to allow for wound stabilization in the setting of hemifacial necrotizing fasciitis. Complex facial wounds can be difficult to stabilize due to proximity of vital structures. ![]()
0 Comments
Leave a Reply. |
AuthorWrite something about yourself. No need to be fancy, just an overview. ArchivesCategories |