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Improving patient outcomes using pre moistened debridement cloths on a chronic diabetic foot ulcer

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Title:

Improving patient outcomes using pre moistened debridement cloths on a chronic diabetic foot ulcer

Introduction:

The management of diabetic foot ulcers (DFU) in Primary Care can be problematic with limited access to specialist services such as sharp debridement, healing these wounds can be challenging. Presented is a case study of a complex non-healing DFU and how a pre moistened debridement cloth was used with remarkable effect to improve wound healing and patient outcomes.

Method:

A 72 year old gentleman with a non-healing diabetic foot wound was referred to Tissue Viability in June 2016. The patient had undergone a trans-metatarsal amputation in March 2016. The wound had been non-healing for four months with a history of recurrent infections and wound deterioration.

The patient had been managed with various de-sloughing and antimicrobial dressings but with little improvement to wound healing. A care plan was developed for the wound to be debrided with a pre moistened debridement cloth three time per week in conjunction with an autolytic debridement dressing regime.

Results:

On initial assessment in June 2016 the wound measured 9cm x 4cm with the greatest depth of 4cm.  The wound bed was 50% well adhered slough. The wound was reviewed in August 2016 at this time the wound measured 6.5cm x 2cm with a greatest depth of 1.5cm. At this time the bed was 100% granulating tissue.

In the six weeks since starting the new care plan a 28% reduction in wound width, a 50% reduction in wound length and a 63% decrease in wound depth was seen. These result demonstrate significant wound healing in a wound which has been non healing for the previous four months.  

The exudate level had reduced to the point that a superabsorbent dressing was no longer required. The patient had a history of a persistent wound infection for three months which was treated with oral antibiotics when reviewed in August the infection had resolved.

 The wound has almost healed in November 2016, five months after starting the new regime.

Discussion:

Patients with DFU are at high risk of infection, gangrene, amputation, and even death if appropriate care is not provided. Nice guidelines recommend that necrotic tissue and slough should be removed by debridement as devitalised tissue acts as reservoir for bacteria growth. Surgical debridement is the gold standard in DFU debridement however this is a specialist skill which the majority of community nurses cannot undertake. Patients would be required to attend frequent hospital appointments for regular surgical debridement to take place which in many cases is unachievable due to the patient’s level of mobility and associated medical conditions. Pre moistened debridement cloths offer an achievable and effective alternative method of debridement in Primary Care.

Pre moistened debridement cloths allow debridement to take place at each dressing change helping to stimulate cell growth and disturb reforming biofilm and slough. The cloth is individually packaged and does not require any further moistening with water or solutions. The cloth is simple and easy to use and requires little skill or specialist training for it to be effective. The cloth is very safe and will not cause trauma, the cloth is a class 2B medical device and is safe to use in cavities and undermining wounds.

Conclusion:

Pre moistened debridement cloths offer an effective solution to the challenge of debriding and managing DFU in Primary Care where surgical debridement is not widely available. Significant wound healing and improved patient quality of life was seen in the presented case study of a non-healing DFU. 

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