Have you tried the best NPWT rental company in the US

After seeing all the big changes going on the durable medical equipment market. The one that always stand out is MedcoAmerica from Louisiana. This company continue to grow even with all the changes on the Medicare/Medicaid changes in our domestic healthcare. The company specialize on Negative pressure wound therapy pumps, NeutroPhase wound cleansing and Black foam dressing. This company controls the wound care market in the south and taking a big chunk of market share from the market leader.

MedcoAmerica is one of the fastest growing npwt pump rental company in the US. They are looking for a distributors and partners across America. If interested, check out their website at www.medcoamerica.com.

 

MedcoAmerica NPWT Pump Rentals

The lightest and portable Cobaltt NPWT pump is now available in the US

I am happy to report that the most up to date, lightest, and convenient Cobaltt negative weight wound treatment pump is presently accessible in the US. This pump was outlined in Germany and by the searches of its fabricated for a tough utilization. This specific NPWT pump might be use in the Hospital, intense forethought, long haul consideration, aided living and home mind setting. The pump accompanies a simple to peruse LCD screen. Cobaltt npwt pump is composed with two npwt treatment modes, persistent and irregular. Whether the doctor endorsed a consistent weight of 125mmhg or an irregular of -125mmhg of high weight for 5 minutes (flexible) and -80mmhg low weight for 2 minutes. The guardian can alter the pump without any difficulty.

I cherish how the pump really accompanies a compact sack for patient you are walking. I see a considerable measure of dynamic patients that need NPWT treatment and they have to be stuck in their rooms while accepting the treatment. They can go out delight on the planet, run hang out with the family at a recreation center, restaurant or wherever they wish to use their day. The pump respects strive for 24 hours once its completely charge. Envision, you don’t need to stress over charging the npwt pump while you are out doing your errands. Yet you just need to charge this Negative weight wound treatment pump for four hours to be completely charge. Cobaltt likewise accompanies two canister choices, 300cc (for low exudate wounds) and 500cc for substantial exudate. Likewise, Cobaltt additionally accompanies a NPWT dark froth dressing packs, which is an injury forethought market standard. Lion’s share of the parental figures in medicinal services offices are well known withe the dark froth dressing change convention which likens to speedier usage of this new NPWT pump in any office. They know how to utilize and put the dressing even without seeing it.

With the Smith and Nephew Renasys Recall happening as of June 2014, numerous solid restorative supplies merchants and NPWT rental organizations have been hit drastically. They have patients that are right now on Renansys NPWT pump and they need to take them off and utilize an alternate npwt pump. In addition I am not certain if Medicare/Medicaid will keep on reimburing the office if the renasys npwt pump is on review. That would be a decent thing to ask immediately. On the off chance that you are a merchant and searching for another npwt pump and needs it immediately. Give the gentlemen at Equinox Medical a call. They can help you experience this NPWT review at this point or until Smith and Nephew settles their issue. This review and resolutions will normally takes something like 120 to 240 prior days you get a reply from the FDA after Smith and Nephew submits their 510k changes.

 

Cobaltt NPWT Pump System by Equinox Medical Cobaltt NPWT Pump by Equinox Cobaltt NPWT Pump User Interface Cobaltt NPWT Pump Canisters Cobaltt NPWT PUmp Canister

Former KCI executive now running another NPWT Pump Company

Do you think hiring someone from your competitor’s team is innovative or just trying to keep up with the competition? The company wants to know what this guy learn from the market leader and hopefully he can implement market leader’s tactics and strategy to his new company.

Spiracur Appoints Chris Fashek as Its New President and CEO

SUNNYVALE, CA, Jul 09, 2014 (Marketwired via COMTEX) — Spiracur, the developer of the only mechanically powered advanced wound care solution that delivers the proven efficacy of Negative Pressure Wound Therapy (NPWT), today announced the appointment of Chris Fashek as president and chief executive officer. With two decades of experience leading health care companies, Fashek will oversee execution of Spiracur’s development and growth strategies as it expands its global presence as a preferred provider of innovative wound healing technologies.

Prior to joining Spiracur, Fashek served as president and vice chairman of Kinetic Concepts, Inc. (KCI) USA, which is the leader in NPWT of the wound care industry. Before joining KCI, he managed businesses in the pharmaceutical and consumer product markets for Sterling Drug, a division of Eastman Kodak in the United States and internationally. Mr. Fashek currently serves as chairman of the Board of Directors for Spiracur, and director of the IDN Summit, the World Craniofacial Foundation, and other commercial and charitable boards. Fashek received his Masters in Business Administration from Fairleigh Dickinson University and a Bachelor of Arts from Upsala College.

“I am very excited to assume this new role at Spiracur at this time, as the company has significant elements in place for expanding its commercial success,” said Fashek. “Spiracur has the opportunity for sizeable growth due to a substantial increase in covered lives including Medicare reimbursement and positive coverage decisions from multiple private payors, as well as being added as an approved product in two of the largest U.S. GPOs. Not only is Spiracur extremely well positioned to enhance wound care treatment for patients who can benefit from NPWT, but this patient population is growing even larger as we announce new product offerings later this year, which expand our technology platform for broader usage,” continued Fashek.

Spiracur is credited with creating a new category of chronic and acute wound management solutions that combine the benefits of advanced wound care with non-powered NPWT. The SNaP(R) (Smart Negative Pressure(R)) System provides patients with a sophisticated, non-invasive NPWT system designed to promote wound healing, which weighs only 2.2 ounces and does not require batteries or electricity.

Several clinical studies have been published supporting the SNaP System as an effective alternative to electrically powered NPWT, including a comparative Randomized Controlled Trial (RCT) that also showed the small device makes a positive difference in patients’ quality of life. Recently, promising data from the multicenter RCT comparing the treatment of venous leg ulcers (VLU) using the mechanically powered SNaP System, to an electrically powered NPWT system, was presented at the Symposium on Advanced Wound Care (SAWC) Spring Conference in April.

According to Spiracur’s chief scientific officer, Kenton Fong, M.D., “This recent RCT data shows extremely promising results for the SNaP System when used to treat venous leg ulcers. Specifically, the data revealed that wounds treated with the SNaP System demonstrated greater improvement and a higher likelihood of complete wound closure than those treated with the electrically powered VAC system.”

About Spiracur Inc. Spiracur Inc., headquartered in Sunnyvale, Calif., is a privately held medical device company focused on the development of innovative wound healing technologies. Spiracur was founded out of the Stanford University Biodesign Innovation Program in 2007. Its first product, the SNaP Wound Care System for the treatment of chronic and acute wounds, is the result of patient and clinician feedback that current negative pressure wound therapies were too cumbersome. The company’s ciSNaP(R) Closed Incision System with proprietary controlled tension relief is designed to improve healing of high-risk surgical incisions. Both devices have received 510(k) clearance from the U.S. Food & Drug Administration (FDA) and have received CE Mark approval. Spiracur’s proprietary mechanically powered technology does not require batteries or electricity to operate. For more information, please visit http://spiracur.com .

Spiracur, Spiracur logo, SNaP, Smart Negative Pressure, and ciSNaP are registered trademarks of Spiracur Inc. VAC is a registered trademark of Kinetic Concepts, Inc.

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KCI settles Wake Forest wound care patent spat for $280M

KCI settles Wake Forest wound care patent spat for $280M

July 1, 2014 by Brad Perriello

Kinetic Concepts Inc. agrees to a $280-million settlement of its long-running patent infringement war with Wake Forest University over negative-pressure wound therapy technology.

KCI settles Wake Forest wound care patent spat for $280M

UPDATED July 1, 2014, with comment from KCI.

Kinetic Concepts Inc. said it agreed to pay $280 million to settle a patent infringement lawsuit with Wake Forest University, putting their long-running war over negative-pressure wound therapy to rest.

KCI licensed the NPWT patents from Wake Forest in 1993, but stopped paying royalties in 2011 after a federal judge in 2010 ruled the patents invalid.

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A year later KCI and wound-care rival Smith & Nephew (FTSE:SN, NYSE:SNN), which had been tussling over the technology since Smith & Nephew’s 2007 acquisition of Blue Sky Medical Group, put their legal battle to rest as well.

Yesterday KCI said that it agreed to settle with Wake Forest via a series of payments covering retrospective royalties on the patents.

The deal calls for KCI to pay $80 million this month, another $85 million in June 2015, $85 million in June 2016 and a final $30 million payment in June 2017, according to a regulatory filing.

The Settlement Agreement includes a stipulated dismissal with prejudice of the lawsuits between KCI and Wake Forest, including the lawsuit that was previously scheduled to begin trial on July 28, 2014 in the U.S. District Court for the Western District of Texas, San Antonio Division.

“We are pleased to have resolved all negative pressure wound therapy patent litigation with Wake Forest. KCI pioneered the use of negative pressure wound therapy products when we launched our first V.A.C. Therapy System in 1994 and in so doing, improved the lives of millions of people. Today, KCI’s V.A.C. Therapy has been the treatment of choice for more than 8 million wounds worldwide and is the most effective therapy for accelerating wound healing,” KCI general counsel John Bibb said in prepared remarks.

Proposal to list surgical sutures, wound care products and disposable laparoscopic trocars and associated instruments

Proposal to list surgical sutures, wound care products and disposable laparoscopic trocars and associated instruments

Published By   /   July 9, 2014  /   No Comments

MIL OSI – Source: Pharmac – Press Release/Statement

Headline: Proposal to list surgical sutures, wound care products and disposable laparoscopic trocars and associated instruments

Proposal to list surgical sutures, wound care products and disposable laparoscopic trocars and associated instruments

8 July 2014

PHARMAC is seeking feedback on a proposal to list a range of surgical sutures, wound care products and disposable laparoscopic trocars and associated disposable instruments (“Medical Devices”) in Part III of Section H of the Pharmaceutical Schedule as a result of a provisional agreement (“Agreement”) with Covidien New Zealand Limited (“Covidien”).

In summary, this proposal would result in Covidien’s ranges of Medical Devices being available for DHBs to purchase at PHARMAC negotiated prices from 1 September 2014, subject to consultation and approval.

PHARMAC estimates that the proposal would offer at least $640,000 in savings per annum to those DHBs that currently purchase the Medical Devices, and could offer further significant savings should any other DHBs decide to purchase the Medical Devices.

DHBs may continue to choose to purchase other suppliers brands of medical devices.

Feedback sought

PHARMAC welcomes feedback on this proposal. To provide feedback, please submit it in writing by 28 July 2014 to:

Maree Hodgson
Procurement Manager
PHARMAC
PO Box 10 254
Wellington 6143

Email: devices@pharmac.govt.nz

Fax:     04 460 4995

All feedback received before the closing date will be considered by PHARMAC’s Board (or its delegate) prior to making a decision on this proposal. Please contact us if you would like to discuss the timing of your submission outside this timeframe. Please note that extending the timeframe is likely to delay the potential savings to DHBs.

Feedback we receive is subject to the Official Information Act 1982 (OIA) and we will consider any request to have information withheld in accordance with our obligations under the OIA. Anyone providing feedback, whether on their own account or on behalf of an organisation, and whether in a personal or professional capacity, should be aware that the content of their feedback and their identity may need to be disclosed in response to an OIA request.

We are not able to treat any part of your feedback as confidential unless you specifically request that we do, and then only to the extent permissible under the OIA and other relevant laws and requirements. If you would like us to withhold any commercially sensitive, confidential proprietary, or personal information included in your submission, please clearly state this in your submission and identify the relevant sections of your submission that you would like it withheld. PHARMAC will give due consideration to any such request.

Details of the proposal

Covidien’s range of Medical Devices would be listed in Part III of Section H of the Pharmaceutical Schedule from 1 September 2014.

The product range includes:

Sutures

  • Biosyn
  • Caprosyn
  • Dermalon
  • Flexon
  • Maxon
  • Maxon CV
  • Monosof
  • Novafil
  • Polysorb
  • Sofisilk
  • Stainless Steel
  • Surgidac
  • Surgilon
  • Surgipro
  • Surgipro II
  • Ticron
  • Velosorb
  • V-Loc
  • Umbilical tape
  • Suture Bolsters
  • Teflon Pledgets
  • Bone Wax

Wound care products

  • Curasorb
  • Curity Multitrauma
  • Excilon
  • Kendal AMD
  • Kendall Copa
  • Kendall Plus
  • Kerlix
  • Mothermates
  • Polyskin
  • Telfa
  • Vaseline dressings
  • Xeroform

Disposable laparoscopic devices

  • Dexide
  • Endo
  • FRED
  • Mini Step
  • Pediport
  • Poly
  • PLDS
  • Premium
  • Roticulator Endo
  • SILS
  • Step
  • Surgineedle
  • Surgisleeve
  • Surgiwand
  • Thoracoport
  • Roticulat
  • Versaport
  • Versaport V2
  • Versastep
  • Visiport

If the Agreement is approved by PHARMAC’s Board or its delegate, Covidien’s range of Medical Devices would be listed in Part III of Section H of the Pharmaceutical Schedule, which contains products with national agreements that DHBs are able to purchase under.

The Agreement includes terms for education services to be provided by Covidien to DHB personnel on appropriate use of its Medical Devices, which is to be provided at times as agreed with individual DHBs.

The exact product list, pricing and specific Agreement arrangements in the proposal have not been included in this consultation for brevity. The surgical suture and disposable laparoscopic medical device ranges both have a tiered pricing arrangement that could offer further savings to the Schedule listed pricing for increased individual DHB commitment. The details of this tiered pricing arrangement and commitment levels would remain confidential and would only be made available to Procurement Departments at DHBs to work through with their clinical teams. Some DHBs already qualify based on current usage of Covidien product for the second tier pricing offered and they will be notified individually.

For the Suture range the Agreement also allows for supplier managed inventory systems to be put in place for those DHBs who wish to utilise this service.

The range of Medical Devices would be listed in Part III of Section H of the Pharmaceutical Schedule. We propose that the Medical Devices would not be individually listed in the printed Section H of the Pharmaceutical Schedule, but rather a reference made in Part III of Section H to an electronic source available on our website in an Excel spreadsheet format, and a PDF document.

Background

In the May 2013 PHARMAC consultation, Surgical Sutures and Wound Care products were identified as 2 of the 11 categories PHARMAC would be working on as part of the phased plan for PHARMAC to progressively take on the management of hospital medical devices.

In August 2013 PHARMAC issued a registration of interest document, seeking proposals from suppliers for non-exclusive national agreements for wound care products. Following the closure of this request, we have been working with a number of suppliers in order to seek to reach an agreement with them, Covidien responded to this request.

In September 2013 a direct approach to the known suppliers in the New Zealand market, with comprehensive surgical suture ranges was made. This approach was in the form of a request for a submission to PHARMAC for a listing on the Pharmaceutical schedule and Covidien responded to this request.

Laparoscopic disposable trocars and associated instruments was not part of PHARMAC’s initial group of categories for medical devices consulted on in May 2013. The opportunity to list these medical devices was presented to PHARMAC following the initial consultation that identified the categories and significant saving opportunities for DHBs was offered. PHARMAC assessed the potential opportunity and determined it was substantial and would be worthwhile pursuing.

Following further consultation with; the sector as a whole, the Royal Australasian College of Surgeons specifically, and DHB Procurement teams, PHARMAC chose to pursue the opportunity offered in the disposable laparoscopic market. In November 2013 a direct approach to the known suppliers with comprehensive disposable laparoscopic device ranges in the New Zealand market was made and Covidien responded to this.

No reusable vs. disposable costing models have been undertaken on this range of medical devices for this process as PHARMAC is looking to obtain improved pricing on disposable products already in use in DHB’s, not advocating a change to disposable products. DHBs role in choosing the mix of disposable and reusable equipment they use would not be altered by this proposal.

The range of products available in all three categories would not be altered by this proposal and DHBs would continue to be able to choose which medical devices they purchase.

PODCAST: Chronic wound care offers insight into battling biofilms

PODCAST: Chronic wound care offers insight into battling biofilms


EXPERT ANALYSIS FROM THE SUMMIT IN AESTHETIC MEDICINE


DANA POINT, CALIF. – “Biofilms are ubiquitous,” said Dr. Robert Galiano, a plastic and reconstructive surgeon at Northwestern Memorial Hospital in Chicago.

“They [bacteria] hijack the body’s healing mechanisms, so instead of healing, … the body’s inflammatory cascade gets amplified to a degree where it actually becomes tissue damaging,” he said at the Summit in Aesthetic Medicine 2014.

Much of what we know about how bacteria communicate with one another to form biofilms comes from research into the prevention and treatment of chronic wounds. More research is needed, but greater understanding of how bacteria communicate with one another to prevent antimicrobial action may lead to new therapeutic targets that could benefit many medical specialties, he added.

Potential therapeutic targets range from coatings for wound dressings to protective barriers on stents and implants of all kinds to extend their durability. In this interview, Dr. Galiano discusses current treatment strategies to manage bacteria, which patients are at greatest risk, and future directions for biofilm prevention.

The summit was held by Global Academy for Medical Education. GAME and this news organization are owned by Frontline Medical Communications. Dr. Galiano had no financial conflicts to disclose.

Repost from WS Journal “Renasys NPWT Pump Recal”

Statement regarding RENASYS(TM) NPWT in the United States

LONDON, June 23, 2014 /PRNewswire/ — Smith & Nephew (LSE: SN; NYSE: SNN), the global medical technology business, announces that it has temporarily ceased commercial distribution of the RENASYS Negative Pressure Wound Therapy product line in the United States.

This action follows instruction from the FDA to obtain new regulatory clearances through the premarket notification (510K) process in respect of certain design enhancements made to RENASYS systems. The applications for clearance have now been filed and are awaiting action.

This action only affects RENASYS products in the United States. Other NPWT products, including PICO(TM), Smith & Nephew’s portable, canister-free system, are not affected.

Smith & Nephew is working cooperatively with the FDA to address its concerns in order to resume distribution of RENASYS products in the United States as soon as possible and regrets any disruption caused to customers.

Sales of RENASYS products in the United States accounted for less than 5% of global Advanced Wound Management revenue in 2013.

About Smith & Nephew

Smith & Nephew is a global medical technology business dedicated to helping healthcare professionals improve people’s lives. With leadership positions in Orthopaedic Reconstruction, Advanced Wound Management, Sports Medicine and Trauma & Extremities, Smith & Nephew has around 11,000 employees and a presence in more than 90 countries. Annual sales in 2013 were more than $4.3 billion. Smith & Nephew is a member of the FTSE100 (LSE: SN, NYSE: SNN).

For more information about Smith & Nephew, please visit our corporate website www.smith-nephew.com, follow @SmithNephewplc on Twitter or visit SmithNephewplc on Facebook.com

Forward-looking Statements

This document may contain forward-looking statements that may or may not prove accurate. For example, statements regarding expected revenue growth and trading margins, market trends and our product pipeline are forward-looking statements. Phrases such as “aim”, “plan”, “intend”, “anticipate”, “well-placed”, “believe”, “estimate”, “expect”, “target”, “consider” and similar expressions are generally intended to identify forward-looking statements. Forward-looking statements involve known and unknown risks, uncertainties and other important factors that could cause actual results to differ materially from what is expressed or implied by the statements. For Smith & Nephew, these factors include: economic and financial conditions in the markets we serve, especially those affecting health care providers, payers and customers; price levels for established and innovative medical devices; developments in medical technology; regulatory approvals, reimbursement decisions or other government actions; product defects or recalls; litigation relating to patent or other claims; legal compliance risks and related investigative, remedial or enforcement actions; strategic actions, including acquisitions and dispositions, our success in performing due diligence, valuing and integrating acquired businesses; disruption that may result from transactions or other changes we make in our business plans or organisation to adapt to market developments; and numerous other matters that affect us or our markets, including those of a political, economic, business, competitive or reputational nature. Please refer to the documents that Smith & Nephew has filed with the U.S. Securities and Exchange Commission under the U.S. Securities Exchange Act of 1934, as amended, including Smith & Nephew’s most recent annual report on Form 20-F, for a discussion of certain of these factors. Any forward-looking statement is based on information available to Smith & Nephew as of the date of the statement. All written or oral forward-looking statements attributable to Smith & Nephew are qualified by this caution. Smith & Nephew does not undertake any obligation to update or revise any forward-looking statement to reflect any change in circumstances or in Smith & Nephew’s expectations.

(TM)Trademark of Smith & Nephew. Certain marks registered US Patent and Trademark Office.

SOURCE Smith & Nephew

/CONTACT: Investors, Phil Cowdy, +44 (0) 20 7401 7646, Smith & Nephew, Media, Charles Reynolds, 44 (0) 20 7401 7646, Smith & Nephew, Trade Media, Suzanne Miller, +1 646 405 5992, Magellan Communications

/Web site: http://www.smith-nephew.com

Repost from WS Journal “Renasys NPWT Pump Recal”

Statement regarding RENASYS(TM) NPWT in the United States

LONDON, June 23, 2014 /PRNewswire/ — Smith & Nephew (LSE: SN; NYSE: SNN), the global medical technology business, announces that it has temporarily ceased commercial distribution of the RENASYS Negative Pressure Wound Therapy product line in the United States.

This action follows instruction from the FDA to obtain new regulatory clearances through the premarket notification (510K) process in respect of certain design enhancements made to RENASYS systems. The applications for clearance have now been filed and are awaiting action.

This action only affects RENASYS products in the United States. Other NPWT products, including PICO(TM), Smith & Nephew’s portable, canister-free system, are not affected.

Smith & Nephew is working cooperatively with the FDA to address its concerns in order to resume distribution of RENASYS products in the United States as soon as possible and regrets any disruption caused to customers.

Sales of RENASYS products in the United States accounted for less than 5% of global Advanced Wound Management revenue in 2013.

About Smith & Nephew

Smith & Nephew is a global medical technology business dedicated to helping healthcare professionals improve people’s lives. With leadership positions in Orthopaedic Reconstruction, Advanced Wound Management, Sports Medicine and Trauma & Extremities, Smith & Nephew has around 11,000 employees and a presence in more than 90 countries. Annual sales in 2013 were more than $4.3 billion. Smith & Nephew is a member of the FTSE100 (LSE: SN, NYSE: SNN).

For more information about Smith & Nephew, please visit our corporate website www.smith-nephew.com, follow @SmithNephewplc on Twitter or visit SmithNephewplc on Facebook.com

Forward-looking Statements

This document may contain forward-looking statements that may or may not prove accurate. For example, statements regarding expected revenue growth and trading margins, market trends and our product pipeline are forward-looking statements. Phrases such as “aim”, “plan”, “intend”, “anticipate”, “well-placed”, “believe”, “estimate”, “expect”, “target”, “consider” and similar expressions are generally intended to identify forward-looking statements. Forward-looking statements involve known and unknown risks, uncertainties and other important factors that could cause actual results to differ materially from what is expressed or implied by the statements. For Smith & Nephew, these factors include: economic and financial conditions in the markets we serve, especially those affecting health care providers, payers and customers; price levels for established and innovative medical devices; developments in medical technology; regulatory approvals, reimbursement decisions or other government actions; product defects or recalls; litigation relating to patent or other claims; legal compliance risks and related investigative, remedial or enforcement actions; strategic actions, including acquisitions and dispositions, our success in performing due diligence, valuing and integrating acquired businesses; disruption that may result from transactions or other changes we make in our business plans or organisation to adapt to market developments; and numerous other matters that affect us or our markets, including those of a political, economic, business, competitive or reputational nature. Please refer to the documents that Smith & Nephew has filed with the U.S. Securities and Exchange Commission under the U.S. Securities Exchange Act of 1934, as amended, including Smith & Nephew’s most recent annual report on Form 20-F, for a discussion of certain of these factors. Any forward-looking statement is based on information available to Smith & Nephew as of the date of the statement. All written or oral forward-looking statements attributable to Smith & Nephew are qualified by this caution. Smith & Nephew does not undertake any obligation to update or revise any forward-looking statement to reflect any change in circumstances or in Smith & Nephew’s expectations.

(TM)Trademark of Smith & Nephew. Certain marks registered US Patent and Trademark Office.

SOURCE Smith & Nephew

/CONTACT: Investors, Phil Cowdy, +44 (0) 20 7401 7646, Smith & Nephew, Media, Charles Reynolds, 44 (0) 20 7401 7646, Smith & Nephew, Trade Media, Suzanne Miller, +1 646 405 5992, Magellan Communications

/Web site: http://www.smith-nephew.com

Interchangeable Skin Grafting to Camouflage Self-inflicted Wound Scars on the Dorsal and Volar Forearm: A Case Report

Interchangeable Skin Grafting to Camouflage Self-inflicted Wound Scars on the Dorsal and Volar Forearm: A Case Report

 

Author(s):

Chang-Yi Chou, MD; Hsin An Chang, MD; Hao-Yu Chiao, MD; Chi-Yu Wang, MD; Yu-shan Sun, MD; Shyi-gen Chen, MD, MPH; and Chih-Hsin Wang, MD

Index: Ostomy Wound Manage. 2014;60(4):50–52.

 

Abstract

Scars from self-inflicted wounds to the upper extremities are the hallmark of self-mutilation. They are easy to recognize and difficult to hide. Camouflaging these scars can be an onerous task. In this case study, a 23-year-old woman who has major depressive disorder with comorbid borderline personality disorder presented for scar repair of self-inflicted wounds on the volar and dorsal forearm (each approximately 10 cm2 x 15 cm2). Following a psychological and physical evaluation, split-thickness skin grafts (10/1,000 inches in thickness) were obtained from both areas and switched. The grafts were fixed with staples, immobilized with a short arm splint, and dressed daily with gauze and neomycin ointment. Staples were removed after 10 days; at the 6-month follow up, the wounds resembled burn wound scars. The patient was satisfied with this more socially acceptable result. This method might offer a simple camouflage option in appropriately selected cases.

Potential Conflicts of Interest: none disclosed

Introduction

Self-inflicted wounds and the resultant scars are viewed as evidence of borderline personality disorder and its comorbidity with other psychiatric conditions.1 These scars are usually thin, multiple, cover a large area, and stretch deep into the dermis or subcutaneous tissue, which makes scar revision difficult. Persons with a history of self-wounding may continue to be stigmatized, especially when the scars are located in an easily visible area such as the lower arms. In addition, they can be a source of lifelong shame, guilt, and regret. Self-inflicted wound scars may cause serious image problems that could disrupt social and professional activities.2

Plastic surgeons often are approached to either completely remove the scars or at least convert them to socially acceptable scars, such as burn wound scars. When the patient seeks surgical aid for relieving self-inflicted scars, a thorough physical and psychiatric evaluation is mandatory.

Such examination should be performed before the surgical intervention; it has been proposed that surgery should not be considered until at least 2 years have passed since the last self-inflicted injury.3

Surgical therapy of self-inflicted scars differs from routine scar correction. Although various treatment options are available for self-inflicted scars, such as elliptical excision of the lesion in a single session, dermabrasion, and tattooing over the scarred area,4 these conventional scar correction techniques and treatment modalities may not effectively change the unique scar pattern. Full-thickness excision of the area and application of a split-thickness skin graft harvested from a remote site,5 microfollicular hair transplantation, and camouflaging self-inflicted wound scars6 are additional options to help reduce and destigmatize scar appearance, but some of these techniques increase total scar area and require the creation of a donor site.

Conversion of the self-inflicted scar into another type of scar, such as that caused by burns, could camouflage the origin of the scarring in this location. This can be achieved with split-thickness excision of the area and a 90˚ reapplication of the excised tissue,7 which converts the transverse to a longitudinal scar without creating a donor site.

The case of a young woman seeking to repair evidence of self-inflicted wounds is reported.

Case Report

Ms. M, a 23-year-old woman who has major depressive disorder with comorbid borderline personality disorder, presented to the authors’ clinic requesting scar repair. She had no other medical comorbidities. Her early life experiences included emotional neglect and sexual abuse. She also had a history of repeated self-inflicted injuries to the nondominant forearm caused by a razor blade during adolescence. Ms. M explained she utilized self-inflicted injuries to relieve or help regulate psychological distress rather than commit suicide. She was aware that feelings of loneliness and an argument with her father caused her to feel emotional pain.

Ms. M had three previous admissions to a psychiatric ward. Following discharge from the hospital, she had several sessions of twice-weekly psychotherapy and irregular psychiatric outpatient follow-up for 5 years.

When she came to the authors’ clinic with a request to transform the self-inflicted wound scars into another type of scar, multiple transverse, pale, roughly parallel scars on the volar and dorsal forearm were noted (see Figure 1). After psychiatric consultation for psychological assessment and detailed discussions with Ms. M and her family, physicians decided to perform the operation to camouflage the most apparent scars. A split-thickness skin graft (10/1,000 inch thick) was harvested from the area of old scarred skin over the volar and dorsal forearm (each approximately 10 cm2 x 15 cm2) (see Figure 2). Next, the skin graft from the dorsal forearm was placed on the volar forearm and that from the volar forearm was placed on the dorsal forearm. The skin grafts were fixed with staples and immobilized with a short arm splint. After the operation, the wound dressing was changed daily with neomycin ointment. Ms. M was discharged on post-op day 3.

 

Following discharge from the hospital, she had weekly follow-up visits at the plastic surgery outpatient department; the staples were removed on post-op day 10. After 6 months, the surgical scar appeared similar to a burn injury scar without any other surgical treatment. Ms. M was satisfied with the result aesthetically and socially and started to back to work (see Figure 3).

Discussion

It is under debate if it is aesthetically acceptable to increase total scar area and to produce another scar in the donor area. In this case, self-inflicted scars were camouflaged without creating a donor site scar. The patient was a good candidate for surgical intervention with interchangeable skin grafting because of her psychological status and because she had both volar and dorsal self-multilation scars. She was satisfied with the aesthetic and social result of this procedure.

Some authors state that the least acceptable aesthetic result leads to maximum patient satisfaction in appropriately selected cases.2

Conclusion

In appropriately selected cases, interchangeable skin grafting is a simple and effective method to convert a self-inflicted wound scar to a socially acceptable scar similar in appearance to a burn wound scar, without creating another surgical wound. In this case, the patient was satisfied with the result, which motivated her to take a more active and productive role in social and business activities.

References

1. Krysinska K, Heller TS, De Leo D. Suicide and deliberate self-harm in personality disorders. Curr Opin Psychiatry. 2006;19(1):95–101.

2. Welch JD, Meriwether KRC, Trautman PRN. Stigmata: part I. Shame, guilt, and anger. Plast Reconstr Surg. 1999;104(1):65–71.

3. Levenkron S. Stigmata: part I (Letter). Plast Reconstr Surg. 2000;105(3):1240–1241.

4. Baytekin C, Menderes A, Mola F, Fidaner H, Barutcu A. Treatment of self-inflicted scars with overgrafting: destigmatization. Internet J Plast Surg. 2006;2(2):8.

5. Guyuron B, Vaughan C. Medical-grade tattooing to camouflage depigmented scars. Plast Reconstr Surg. 1995;95:575.

6. Gozu A, Ozsoy Z, Solmaz M. Microfollicular hair transplantation may be a simple solution to camouflage self-inflicted wound scars on dorsal forearm. Ann Plast Surg. 2006;56(2):224–226.

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Dr. Chou is a plastic surgeon, Division of Plastic Surgery, Department of Surgery, Tri-Service General Hospital, National Defense Medical Center, Taipei, Republic of China; and Department of Surgery, Taoyuan Armed Forces General Hospital, Twoyuan, Republic of China. Dr. Chang is a psychiatrist, Department of Psychiatry, Tri-Service General Hospital, National Defense Medical Center. Dr. Chiao and Dr. CY Wang are plastic surgeons, Division of Plastic Surgery, Department of Surgery; Dr. Sun is a family physician, Department of Family and Community Health; and Dr. Chen is Director of Plastic Surgery and Dr. CH Wang is a plastic surgeon, Department of Surgery, Division of Plastic Surgery, Department of Surgery, Tri-Service General Hospital. Please address correspondence to Dr. Chih-Hsin Wang, Plastic Surgeon, No. 325, Sec. 2, Chenggong Road, Neihu District, Taipei City 114, Taiwan (Republic of China) Taipei; email: super-derrick@yahoo.com.tw.

Intuitive Surgical Receives FDA Approval For da Vinci Sp Surgical System

Intuitive Surgical Receives FDA Approval For da Vinci Sp Surgical System

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The FDA recently granted 510(k) initial clearance to Intuitive Surgical’s da Vinci Sp Surgical System.  The approval is specific to single-port urological surgical procedures for adults.

According to Intuitive’s press release, the system consists of a single 25 mm cannula equipped with three fully articulating EndoWrist Sp Instruments and a 3D HD camera. The instruments include flexible endoscopes, forceps, scissors, retractors dissectors, and electrocautery components that allow the surgeon to manipulate, grasp, cut, and dissect tissue. It is also capable of “approximation, ligation, electrocautery, and suturing through a single incision laparoscopic approach.”

Intuitive claims that the system gives the surgeon more precise control during laparoscopic procedures because its EndoWrist Sp Instruments are fully wristed and offer seven degrees of freedom — two more than da Vinci Single-Site Instruments.

“Our development of this single-port technology represents our foundational commitment to advancing tools for minimally invasive surgery,” Gary Guthart, Intuitive Surgical’s president and CEO, said in the press release.

Intuitive said that the da Vinci Sp Surgical System (SP999) is compatible with its da Vinci Xi Surgical System, which is aimed for release during the second half of 2015 pending regulatory clearance.

The da Vinci Surgical System allows surgeons to sit at a console while performing surgery. Surgeons look at a magnified 3D HD display of the surgical field while manipulating robotic arms and instruments. Intuitive claims that the system reduces fatigue for the surgeon while reducing torque and the risk of trauma to the body.

However, a spate of lawsuits and product recalls has brought the surgical system’s safety record into question. “Since 2008 the FDA has issued five pages of recalls against the company,” according to The Street. The FDA also recently issued a warning to surgeons that using robotic surgical tools may spread cancer during hysterectomies and myomectomies.

Intuitive Surgical’s first quarter earnings plummeted 77 percent after a drop in sales of its da Vinci surgical systems, according to the Wall Street Journal. The company also downgraded the projected number of procedures using its system from between 9 and12 percent to between 2 and 8 percent in 2014, according to a separate report by the Journal.

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