RAPID DEBRIDEMENT OF A STAGE III PRESSURE ULCER OVER ISCHIAL TUBEROSITY WITH A POLY-ABSORBENT FIBRE DRESSING AS PART OF TREATMENT PROTOCOL – A CASE STUDY
LINDSAY YOUNG, NATALIE ARMSON, MARTIN TADEJ
The total annual NHS cost of managing 2.2 million wounds and associated comorbidities is estimated to be £5.3 billion of this, £2.1 billion is estimated to be associated with managing wounds that are healed, but much higher amount, £3.2 billion was associated with managing those wounds that remained unhealed (Guest et al, 2015). Pressure ulcers pose a very significant health risk to patients and contribute to the overall health economic burden of chronic wounds. • As the population ages, the incidence of pressure ulcers will increase. Between 2000 and 2020 the UK population over 65 is forecast to increase from 9.2 million to 11.3 million, an increase of 23%. By 2020 those over 65 will comprise one in five of the total population (Bennett, Dealey and Posnett, 2004). • Estimated cost of treating Pressure Ulcers to the NHS was estimated to be between £1.8 – 2.6bn in 2008 (Posnett and Franks, 2008). Given the demographic outlook, the overall cost of treating pressure ulcers is likely to increase in the future. It is therefore vital to employ simple and effective treatment methods in order to achieve fast and reliable good clinical outcomes. The following case study is an example of simple and effective treatment method for a patient with Stage III pressure ulcer.
A 77 year old male patient with a history of paraplegia and suffering from multiple co-morbidities significantly restricting his mobility. Consequently he was spending long periods in a seated position. He had an active dynamic acute mattress in-situ with a high specification foam cushion in his wheelchair and an active cushion on his riser recliner. He was taking Gabapentin and Levothyroxine as the only regular medications prescribed. • In early April 2016 a deep tissue injury was first noted and recorded over the right ischial tuberosity. This was deemed unavoidable following investigation. Stage III pressure ulcer was then diagnosed as a consequence which needed rapid debridement in order to start the healing process. • Hydrocolloid dressings were used on alternate days for the first 3 weeks (until 25th April 2016) to soften the non-viable necrotic plaque within the wound bed. Once this began to lift, a desloughing poly-absorbent fibre dressing UrgoClean Rope was used with an absorbent healing matrix adhesive border dressing to retain the primary contact dressing. • This combination was changed daily for 2 weeks (until 2nd May 2016) when the wound had sufficient depth to be packed with a poly-absorbent fibre UrgoClean Rope dressing to assist with autolytic debridement. • In contact with exudate, the desloughing poly- absorbent fibres gel and bind to the sloughy residue, absorbing and draining it to aid its elimination. The dressing was changed on alternate days and this plan was followed until the 1st of July 2016 when the wound bed was sufficiently clean to commence Topical Negative Pressure (TNP) wound therapy and continued to granulate well. The wounds’ dimensions at its greatest were 9cm wide, 7cm length and 6cm depth.
On the 14th of May 2016 thick eschar began to autolytically debride at one edge of the ulcer. This was followed by a very rapid pain free reduction in the necrotic tissue covering nearly 100% of the wound bed initially (photo 1). • After just 7 days a large part of the wound was debrided showing granulation tissue. The desloughing poly- absorbent fibre dressing continued to effectively debride the wound bed while protecting the peri- wound and allowing pain free desloughing process. When the wound was free from necrotic tissue Topical Negative Pressure Assisted Wound Closure Device was introduced on the 06/07/2016 (photo 3).
Strategies to reduce the incidences of pain, infection and slow healing should be employed in order to minimize the time necessary to healing the wound as well as to maximise patient’s quality of life. • The patient described in this case suffered from unavoidable pressure ulcer Stage III. The aim was to debride and close the wound as fast as possible. It is often a challenge as debridement is often associated with trauma, pain and techniques not available to wide scope of clinicians. • The use of the desloughing poly-absorbent fibre dressing allowed for a rapid decrease in the necrotic tissue and pain free wound bed preparation process allowing for optimisation of care.
Pressure ulcers pose a significant cost burden to healthcare services and also pose a significant problem to patients, adding to an already reduced quality of life. Effective wound bed preparation widely available to practitioners described in this case, offers an excellent choice and promises good and reliable future outcomes for patients who need rapid pain free wound desloughing.