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A 65-year-old woman with Wegener's
granulomatosis and - related pulmonary disease developed
an Achilles ulcer. A period of wound care and stabilization
of disease induced some "granulation tissue",
a proliferative wound module, and indicative of
wound healing competence. However, because of tendon
shearing, this wound cannot heal easily, even in
a healthy person, and with active disease, risks
to wound and patient are high.
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In surgery, the wound was excised,
and the tendon was decorticated until only healthy
fibers remained. The blue lines are the design for
a reverse sural nerve flap and donor site skin grafts,
considered then rejected in favor of utilizing Integra.
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Integra is shown here incorporated
into the wound and ready for skin graft
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Two months later, the tendon is
healed and stable
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Cases Courtesy of:
Marc E. Gottlieb, M.D., Jennifer Furman
Journal of Burns and Wounds, Vol 3, #2
