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Management of Necrotising Leukocytoclastic Vasculitis using a new antimicrobial dressing with cleaning action

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INTRODUCTION The nature of wound care presents challenging and ever changing experiences. Leukocytoclastic vasculitis (LCV) is an uncommon disorder which is also referred to as hypersensitivity vasculitis or hypersensitivity angiitis. Necrotising Leukocytoclastic vasculitis is an alternative form of vasculitis characterized by the inflammation of the tiny blood vessels of the body. It can be acute or chronic and patients can experience devastating wound lesions. Wounds of this nature can become chronic and therefore challenging and are frequently at risk of an unbalanced bacterial load therefore a treatment plan that includes antimicrobial
wound dressings are frequently considered. Antimicrobials can include topical disinfectants, antiseptics and antibiotics. Wound care dressing products that contain iodine, potassium permanganate or silver all fall within the category of being antiseptic in nature. During the initial assessment of this patient the Tissue Viability Specialist Nurse (TVN) noted that both feet were malodorous with ulcerated areas having 100% green or yellow slough present. There was a moderate amount of purulent exudate with no cellulitis or erythema visible. Additionally, the 2nd, 3rd + 4th mid toes on the left foot were necrotic. 
METHOD During the admission of this 44 year old gentleman to the Intensive Care Unit for hypotension and renal failure, exacerbation of his Necrotising Leukocytoclastic Vasculitis was also identified. Both feet suffered with extremely painful blisters which resulted in ulceration and the need for entonox and morphine to be given for pain relief during dressing changes. Prior to the tissue viability team involvement the patient was very anxious during his dressing changes as he described them as a bad experience. The previous dressing regime prior to this admission included the use of potassium permanganate soaks, an antimicrobial hydrogel plus and a super absorbent dressing for a period of >4 months. The TVN received a referral and identified the need for multidisciplinary team input. With guidance
from the TVN the wound dressing change routine was amended. Ward staff Mondays, Podiatry Wednesdays and a final weekly review and dressing change TVN Fridays. When UrgoClean Ag, the new antimicrobial dressing with cleaning action was available to evaluate, the TVN amended the dressing regime to: • UrgoClean Ag • potassium permanganate (note the brown discolouration in the photos) • super absorbent dressing • retention bandage. On commencement of this regime it was documented that both feet had virtually circumferential partial thickness ulceration with 100% slough present.

DISCUSSION Wound Infection can be treated systemically or topically but frequently they are used concurrently. The combined action of the silver ions within the TCL-Ag matrix combined with the poly-absorbent fibres provided a complete cleaning action to fight the local infection with the clinical signs of infection notably reduced. When in contact with the wound, the polya- bsorbent fibres trap and bind any wound debris such as slough, exudate and possible biofilm away from the wound bed. Additionally the TLC-Ag healing matrix supports a moist wound healing environment and offers a sustained release of silver to the wound bed and pain-free removal at dressing change.

CONCLUSION UrgoClean Ag clearly demonstrated efficacy as each dressing change confirmed the continuing reduction in clinical signs of infection and the percentage of slough present, resulting in a positive impact for the multi- disciplinary clinical staff and the patient. UrgoClean Ag  provided the gentleman with immediate progression along the wound healing continuum and more importantly removed his anxiety during dressing changes as he experienced no pain at all. Although the trust policy is to use silver dressings for a 2-4 week period; at each weekly Tissue Viability assessment, it was considered a necessity to continue with UrgoClean Ag, as the wound healing progression was significant and the patient was at very high risk of recolonisation

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