Endoscopic Aided Debridement Technique
(New tools for the management of tunneled
and undermined wounds)
Charles Andersen MD, FACS, FAPWCA
Clinical Prof of Surgery UW, USUHS
Chief Vascular/Endovascular/ Limb
Preservation Surgery Service
Medical Director Wound Care Clinic,
Madigan Army Medical Center

Trends in Surgery
 Move from major open surgical procedures
to less invasive techniques
 Vascular Surgery – major shift to
endovascular therapy (80%)
 General surgery – major shift to
laparoscopic procedures
 Orthopedic – shift to arthroscopic
 Wound Care – how can we shift

Defining the Question
 Aslimb preservation providers or wound
care specialists how many times are we
faced with questions like:
– Is there infected bone at the end of that sinus
tract?
– Is there a retained foreign body in that sinus
tract
– What can we safely put into that wound i.e.
negative pressure therapy

Goals
 Discuss tools and techniques available for
assessment and treatment of tunneled
wounds
 Introduce the concept of woundoscopy

Recurrent Sacral Pressure Ulcer
 22 y/o female with Spina Bifida
 Previous Large ulcer treated with excision
and flap closure
 Post op infection
 Wound gradually decreased in size
however large cavity with purulent
drainage developed and a CT suggested
osteomyelitis
 Left with sinus tract and a large cavity

Recurrent Sacral Pressure Ulcer
“Small Hole – Big Wound”
CT suggesting osteomyelitis
and necrotic tissue in the
base of wound

Woundoscopy, Debridement and Bone
Biopsy
Arthroscope and Versaget Hydrodebridement

Wound Bed Preparation
with Instill VAC

Instill VAC
Intracavitary negative pressure therapy,
Irrigation, compression of flaps

Abdominal – Sinus Tract
 Complicated GYN procedure
– Post op sepsis with wound infection,
necrotizing abdominal wall infection
– Resection of infected fascia, skin and
subcutaneous tissue
– After control of infection fascial closure with
biological substitute
– Post op wound infection with sinus tract

Infected Abdominal Wound with
Sinus Tract
Medial and lateral wounds
with a connecting sinus tract

Management Questions
Does the wound need to be reopened ??
Is the fascia intact
Is there a tract into the peritoneal cavity
Is bowel exposed – is there a bowel fistula
How to manage the wound
Can those question be answered without
Opening the wound??

Wound Management
• White foam in each wound
extending to the midline
• Negative pressure therapy
• Slow withdrawal of foam with sealing of
the sinus tract

Negative Pressure Application
Frame the wounds
Black foam large enough for TRAC pad
With white foam increase negative pressure
Withdraw white foam with each application

Case – Blast injury from OIF
large wound with flaps
 Illustrates priming the flaps and sealing
the flaps
 White foam for tunnels

Prime the Undermining
Pulse Lavage

Priming the flaps

Sealing the flaps

Flaps Sealed

Closure

Conclusions
 Wound therapy can follow the surgical
trend of utilizing less invasive techniques
for the evaluation and treatment of
wounds
 Woundoscopy can decrease the need for
open exploration of wounds
 Negative Pressure Therapy can help heal
sinus tracts and seal flaps

THANK YOU
Madigan Army Medical Center
Tacoma. Washington