Case Study

Nurse practitioner in trainee Marloes Waindrich, Isala Zwolle

A 26-year-old man presents himself at the emergency room with a gunshot wound to the left upper leg.

There is a distal femoral fracture to the left where some gunpowder is still in situ. Injury to the AFS and a lot of damage to soft tissue.

Multiple ORs with external fixators, cement spacer + AFS recovery through Viabahn.

Trauma wound on the left upper leg due to gunshot wound underwent washout and debridement several times in the OR. (Figure 1)

After a week a VAC system is placed with VAC Veraflo starting with NaCL 50cc. Soaking time was 10-minutes, followed by 4 hours of continues negative pressure at -125 mmHg. Dressing changes occurred twice a week. Local debridement took place during the changes.(Figure 2)

At two weeks the wound remains mildly sloughy. Patient is started with AB iv, augmentin.

After MDO trauma, VAC Veraflo is started with the start of vancomycin (off-label use). Soaking time was 10 minutes, followed by 4 hours of continues negative pressure at – 125 mmHg. Dressing changes occurred 3 times a week. (Figure 3)

After 1 week OK to place final T2 in femur.

Afterwards treated with regular VAC therapy with alternation 2 x per week, after 1 week sufficient soil to place SSG. Followed with VAC therapy with white foam + granufoam. This was removed after 5 days. (Figure 4 and 5)

The patient recovered well and has no problems mobilizing.

Figure 1. Wound a day after first surgery
Figure 2. Wound after V.A.C Veraflo therapy with NaCl
Figure 3.Application V.A.C Veraflow with Vancomycin (off-label use)
Figure 4. Application SSG
Figure 5. Wound after SSG