A crossover case study to compare the effectiveness of Hydroclean plus Mini (Hydro Responsive Wound Dressing) versus primary foam post amputation
This purpose of this crossover study aims was to evaluate the effectiveness of Hydroclean plus Mini dressing on healing foot wounds when compared to a moist healing primary foam dressing.
Evidence suggests that wounds heal best in a moist environment to allow migration of epidermal cells, promote autolytic debridement and protect granulation tissue. The ideal dressing should, therefore, absorb and remove excess drainage and provide protection; such as a foam dressing. 1
Product literature for the hydro responsive wound dressing (HRWD) would indicate that it’s impregnation with Ringers solution allows for continuous irrigation, aiding the natural process of autolytic debridement. Hydro clean plus mini is cytoprotective, cleansing the wound without damaging cells key in the granulation and remodelling phases of healing, such as fibroblast and myofibroblast. The dressing also has a rinse and absorption mechanism where by necrosis, fibrinous material, bacteria and exudate are absorbed into the pad reducing the risk of infection and promoting moist wound healing.2
The participant was a 28 year old male smoker who first presented to the emergency department with frost bite, both hallux particularly affected. Over the next few months the participant underwent vascular assessment and was found to have two vessel occlusive disease with peroneal single vessel run off bilaterally. He was also suspected to have Berger’s Disease. At this point the participant was given an infusion of Iloprost and ceased smoking immediately. His feet were being managed conservatively at home but during this time he developed wet gangrene in both 1st digits. Almost 8 months after first presentation he underwent bilateral hallux amputation, healing by secondary intention. At this stage the participant was invited onto the evaluation study.
Both amputation sites presented with a similar appearance post operatively, no infection and high pain levels. At this point the participant was invited onto the crossover study. The left hallux amputation wound measured 2.88cm2 at first visit and received the HRWD (active dressing); the right hallux amputation wound measured 3.45cm2 and received the primary foam (control).
The participant agreed to attend clinic twice a week for the period of the study, he received post-op offloading sandals and optimised standards of care;
•Wounds were cleansed and sharp debrided to remove slough and wound debris
•Monitored for infection
•Both wounds were photographed against a linear scale
•Traced using acetate wound grid
•Wound area calculated using Image-J software.
After 4 weeks the control dressing was then crossed over to the HRWD. The steps above were continued to wound healing - defined as complete epithelisation of wound bed with no exudate.
Outcome measures included % reduction in wound area and estimated % of wound bed granulation. The most significant findings were as follows;
Week 1: Wound area reduction: active 10% versus control -30%
Wound bed granulation: active 15% versus control 10%
Week 4: Wound area reduction: active 69% versus control 49%.
Wound bed granulation: active 80% versus control 70%.
Week 6: Wound area reduction: active 83% versus crossover 71%.
Wound bed granulation: 100% versus crossover 100%.
Week 8: Wound area reduction: active 99% versus control 77%.
Wound bed granulation: active 100% versus control 100%.
Week 10: Wound area reduction: Active 100% versus crossover 94%.
Wound bed granulation: Healed versus crossover 100%.
Week 14: Both healed.
The wound dressed with the primary foam dressing initially increased in size by 30%, this slowed the overall rate of healing compared with the HRWD. At point of crossover the wound area was 20% greater than the wound dressed with HRWD at baseline. Following two weeks of HRWD the percentage area difference had almost halved. By week 10 the wound that received the HRWD at baseline was healed and the crossover wound area reduction was 94%, difference of just 6%
The following observations were made.
1.Less pain was noted during dressing changes when using the HRWD, the HRWD did not adhere to wound edges.
2.The peripheral skin was healthier in appearance as compared to standard foam dressing.
3.The HRWD aided autolytic debridement more rapidly than the standard foam dressing.
These results would suggest the hydro responsive dressing has shown the ability to promote autolytic debridement and initiate healing at a quicker rate in these amputation wounds when compared to a standard foam dressing.
The Journal for Nurse Practitioners. 2016. Principles to Guide Your Dressing Choice. [ONLINE] Available at: https://www.npjournal.org/article/S1555-4155(15)01190-3/fulltext. [Accessed 9 July 2019].
Hartmann. 2019. Hydroclean Plus. [ONLINE] Available at: https://hartmann.info/en-GB/our-products/Wound-Management/Advanced-Wound.... [Accessed 16 July 2019].