Karaya* Treatment of Infected Stumps

0. JAMES HURT, M.D. GLADYS C. WALLACE, R.N.


*Dermagard, obtainable from John F. Greer Co., Oakland, Calif.

The Karaya treatment of infected stumps was started at the Louisville Veterans Administration Hospital by one of the authors (G.C.W.) and has been used successfully to treat decubiti and other ulcers over a period of years. The treatment is exacting and each step must be followed carefully.

The ulcer is irrigated gently, first with Phisohex solution, then with normal saline, then with hydrogen peroxide. Next the skin is patted dry and the healthy skin surrounding the wound is massaged gently for three minutes. The Karaya gum ring is placed around the ulcer. A Reston pad is cut to fit the Karaya ring. The ulcer is covered with Karaya powder. This, in turn, is covered with plastic (Saran wrap). The Reston prevents pressure to the area. Powder is added every eight hours. Each day the Karaya gum ring is removed and the process is repeated until the ulcer has healed ([popup1A], [popup1B], [popup1C], and [popup1D]).

When this treatment was first used at our hospital, some skepticism concerning its value was expressed. Therefore, it was difficult for us to believe that ulcers that had not responded to any other treatment were responding to this procedure. However, "seeing is believing" and now we are convinced ([popup2A], [popup2B], [popup2C], [popup2D], [popup2E], [popup3A], and [popup3B]).

After seeing ulcers of various kinds throughout the hospital respond to the "Wallace treatment" it naturally followed that the technique should be tried on infected stumps.

Case Report No. 1

The first amputee given the Karaya treatment was T. E. A., a 48-year-old male. He was admitted Mar. 8, 1972, and discharged Apr. 25, 1972. His initial diagnosis was chronic osteomyelitis of the right ankle. On Mar. 10, 1972, he had an open below-knee amputation. This was revised, still at the BK level, on Apr. 11, 1972.

This patient had requested an amputation for an osteomyelitis which had been draining since 1944. His request was granted and an open amputation was done. Five pounds of skin traction were applied. He developed an infection with swelling of the thigh and symptoms of thrombophlebitis. The infection did not improve with antibiotics. In desperation the "Wallace treatment" was started on Mar. 30, 1972. The stump cleared rapidly and was closed twelve days later ([popup4A] and [popup4B]). His prosthesis was ordered May 7, 1972.

Case Report No. 2

Patient H.S. was admitted to the hospital on Nov. 16, 1971, at the age of 67. He was discharged on June 2, 1972. His diagnosis was that of a generalized arteriosclerotic disease. He had had a lumbar sympathectomy, left, on Dec. 21, 1971, a femoral-popliteal vein bypass graft, Feb. 11, 1972, and a below-knee amputation, left, on Feb. 28, 1972.

The wound opened on Mar. 3, 1972. Response to treatment was poor and the Orthopaedic Service in consultation recommended the "Wallace treatment." This procedure was started May 6, 1972, and by May 22, 1972, the patient's stump looked good enough for him to be discharged. Subsequently he was fitted with a prosthesis and ambulated well.

Case Report No. 3

Patient J.C. was admitted to the hospital on Apr. 2, 1973, at the age of 50 years. He was discharged May 19, 1973. His diagnosis was that of osteomyelitis, left tibia. He had an open below-knee amputation on this limb Apr. 3, 1973 ([popup5A]). A secondary closure was done on Apr. 24, 1973.

This patient requested an amputation for osteomyelitis. The amputation was done and skin traction applied. The stump did not clear as rapidly as desired, so the "Wallace treatment" was started on Apr. 16, 1973. The stump did well following closure ([popup5B] and [popup5C]).

Case Report No. 4

W.P. was admitted to the hospital on Feb. 14, 1973. He was discharged on May 8, 1973. His condition was diagnosed as gangrene of the fourth and fifth toes. A left below-knee amputation was done on Feb. 16, 1973. Drainage of the infected incision was carried out on Mar. 2, 1973.

The "Wallace treatment" was started on Mar. 12, 1973 ([popup6A] , [popup6B], [popup6C], and [popup6D]) and discontinued on May 22, 1973. The patient was seen in the Surgical Clinic July 3, 1973. At that time it was felt that he would need a revision of his stump before fitting with a prosthesis should be considered.

Conclusions

Although rigidly controlled studies have not been conducted, the results obtained from this method of treating ulcers and infected stumps indicate its effectiveness.

Descriptors: Amputations: decubiti; Dermagard: Karaya; ulcers.

Veterans Administration Hospital, Louisville, Kentucky

Veterans Administration Hospital, Louisville, Kentucky