Impaired Healing of a Donor Site Following Harvest of Bone: A Case Study
1Lauren Wolfe, BSN, RN, CWOCN, WOC Nurse, Vancouver Coastal Health, Vancouver, British Columbia, Canada.
Background:
A 77-year-old man with diabetes mellitus and hypertension experienced wound dehiscence and tissue necrosis following harvesting of bone from the mid-portion of his right fibula needed to create an osteofascial cutaneous graft, a free flap removing an artery and a vein to the bone-fibula and skin, via peroneal vessels.
Case:
The patient experienced delayed wound healing due to multiple local and systemic factors, including possible venous insufficiency and effects related to radiation treatment to his jaw. He was referred to Home Health for wound care related to dehiscence of the surgical bone donor site. This case study describes assessment and management of this complex wound.
Conclusion:
Our experiences with this case reinforce the need for thorough assessment of both local and systemic factors when managing a complex wound. We recommend evaluation of lower extremity vascular status prior to surgery. We further recommend consideration of postoperative compression bandaging of the lower limb, after ruling out arterial insufficiency, to assist venous return. The course of wound healing in this case also suggests that the effects of radiation on wound healing are not limited to the area being radiated.
