HydroTherapy wound healing of a post amputation site
Diane Knowles1, Lisa Wright1 & Elaine Ricci2
Background: A 61 year old male patient with type 2 diabetes and multiple co-morbidities including peripheral arterial disease, neuropathy, retinopathy and maculopathy, chronic obstructive pulmonary disease, ischaemic heart disease, coronary artery bypass grafting and stroke.
Wound History: The patient had a necrotic infected blister, present for two months. As a consequence, the patient underwent an amputation of the 5th digit and metatarsal which required extensive surgical debridement. The patient was discharged into the multidisciplinary team diabetic foot clinic for wound care and diabetes management. This wound (8.0 x 9.0 cm) initially presented with 90% slough, 10% granulation tissue but with minimal tissue covering the bone below (Figure 1). The wound was offloaded using a trauma sandal. A number of different dressings had been used to debride without success therefore HydroTherapy was used in attempt to initiate healing.
Treatment with HydroTherapy: The wound was treated primarily with HydroClean® plus, 10 x 10 cm. This was secured with Hypafix and a dressing pad with a trauma sandal. Following the initial treatment period, it was observed that visible slough reduced and granulation tissue increased (Figure 2). There was concomitant changes to wound dimensions (7.0 x 8.0 cm) over a period of one week (Figure 3), reducing considerably (5.5 x 2.5 x 0.3 cm) over the treatment period (Figures 4 and 5). The high pain levels suffered initially by this patient (VAS 5.0) reduced significantly over the period of treatment such that the patient no longer required opiate pain control.
Conclusion: HydroClean® plus used to debride and de-slough and aid in wound bed preparation, followed by HydroTac® which maintained an optimum environment and promoted re-epithelialisation, was beneficial to the healing progress of this wound. It is also noteworthy that HydroTherapy appeared to significantly reduced the level of pain suffered by this patient. This was demonstrated by the reduced need for opiate pain control.