APPLICATION OF A TWO-LAYER COMPRESSION BANDAGE SYSTEM, URGOKTWO, USED DIRECTLY ONTO A SPLIT THICKNESS SKIN GRAFT IMMEDIATELY IN THE OPERATING THEATRE TO OPTIMIZE WOUND HEALING – A CHANGE IN PRACTICE
INTRODUCTION As specialist nurses working within the field of Plastic Surgery the range of wounds that we manage vary dramatically. The patients’ age span is also varied with a high percentage of the younger patients wanting to return to normality as quickly as possible. METHOD Venous disease can exist undiagnosed until a problem occurs, such as a traumatic wound not progressing along the healing trajectory as expected, leading to the wound becoming chronic. Skin grafting is often considered a popular procedure to manage complex, static or extensive wounds, however, patients with venous disease are at high risk of skin graft failure. It was considered that applying compression immediately post skin grafting, whilst the patients were still in the operating theatre, was a way to ensure that the skin graft remained viable.
DISCUSSION Managing the patient holistically is routine but particularly for patients who still have very active lifestyles, whether during their working life or personal life. It is imperative that we as clinicians explore alternative ways of healing wounds allowing individuals to continue as near normally as possible. Patient 1 tolerated both forms of compression (UrgoKTwo and Altiform compression stocking) well and was delighted with the outcome. Without the application of the UrgoKTwo the graft would have been likely to fail. The patient would have been left with a wound that would require further treatment. The impact of this would be the patient requiring further time off work affecting him professionally, socially and psychologically. Patient 2 was unable to return to work doing normal duties until his wounds had healed, therefore, expediting healing was imperative. UrgoKTwo was reported as comfortable and allowed him to wear his training shoes, lead a more normal lifestyle and return to work + sports within a 4 week period. Both patients continue with Altiform Made- to-Measure compression hosiery.
CONCLUSION Within Plastic surgery, historically the treatment of lower limb wounds would be one of conservative management and subsequent compression therapy. However, the application is often delayed due to the need for adequate autolytic debridement of the wound prior to this being considered. Once this has been achieved the patient is then referred to a community leg ulcer clinic which will result in a further delay in treatment, as the patient would need to be added to a waiting list for a Doppler assessment. The aim of this change in practice is to avoid a delay in healing, as the Complex Wound Clinic would Doppler patients on their first review to see if they were suitable for compression therapy. This provides a holistic assessment and rules out any Arterial disease allowing wound bed optimisation for surgery and application of compression directly onto the new skin graft whilst the patient is still in theatre. These patients are then discharged home on the same day and return for continuity of care to the Complex Wound Clinic. Once full healing has been achieved this patient group progress onto Hosiery garments for continued management of their underlying venous disease. Using UrgoKTwo, a two-layer compression bandage system, the patients found it comfortable which achieved concordance. In addition to this staff found it easy to apply in a hospital theatre environment.