Limb Salvage of Left Upper Extremity workplace degloving injury contaminated by chicken excrement

The patient is a 38 year old male with no prior medical history who was admitted to the Abrazo West Campus hospital on 11/9/2020 secondary to an acute traumatic degloving injury to his left arm/forearm. The patient worked in a chicken processing factory where he was in charge of maintaining a conveyor belt.   

In an attempt to fix a stuck pulley, the patient got his left arm caught in a conveyor belt carrying chicken excrement, feathers and discarded body parts while the machine was running. 

The patient had a severe degloving traumatic wound to the left arm and forearm sparing most of his hand. 

The patient was initially seen by the trauma surgeon and plastic surgery teams for routine debridements in the operating room.However, the patient remained septic secondary to wound being contaminated by Candida Albicans and Aspergillus fumigatus. 

The patient was then started on an instillation negative pressure wound therapy with Prontosan wound irrigation solution as well as implementation of Stimulan beads soaked in Voriconazole. This treatment was in conjunction with intravenous antibiotics and antifungals prescribed by the infectious disease physician.  By 11/30/2020, the plastic surgery team felt that much of the soft tissue necrosis improved with areas of bioburden remaining. 

The patient was transitioned to Integra soaked with Voriconazole and Amphotericin B which help improve granulation.The patient on 12/2/2020 underwent a flap procedure and transitioned to a skilled nursing facility.