Post on 04-May-2018
COMPLICATIONS FROM THE USE OF SILVER NITRATEON WOUNDS WITH CELLULOSE DRESSINGS
Authors: Scott Bolhack, MD; Barbara Viggiano, RN; Shirley Grant, LPN; Victoria Hensley, RN
BackgroundComplications from the use of products in the wound center are frequently
underreported in the literature due to many reasons: lack of evidence (multiple
products being utilized at the same time or in rapid sequence), insufficient time
allotted to report, and attributes associated to the wound and not to the product.
Observation The use of silver nitrate is well established in the care of wounds for two main
purposes: hypergranulation and to cauterize bleeding wounds that do not stop
with simple compression. We report two cases that involved the use of silver
nitrate on wounds with the subsequent choice of a cellulose dressing over the
wound. In both cases, the cellulose dressing liquefied the silver nitrate in the
wounds and resulted in periwound leakage in the surrounding healthy skin. In
one of the patients, the leakage resulted in pain where the silver nitrate leaked;
in the other patient, the patient and the spouse were concerned about damage
to the periwound area due to discoloration but no pain occurred.
Actions Due to these two cases, we no longer use cellulose dressings if silver nitrate
has been applied to the wound as part of the treatment plan. The cellulose
dressings are unique in that they purport to have dual properties as it relates
to moisture control in the wound: absorption of fluid and tissue hydration
depending on the wound. This interaction of these two classes of products has
not been reported in the literature.
Case One
This patient had the edges of the wound cauterized with silver nitrate
after debridement. In this case the patient did have burning from
the liquefied silver nitrate; however, no damage occurred to the
underlying tissue.
Case Two
This patient has hypergranulation tissue that was cauterized with
silver nitrate. The spouse took this photograph at home to show us
what had occurred. In this case, no pain occurred from the leakage
and there was no skin damage.
THE USE OF BIOELECTRIC DRESSINGSFOR WOUNDS DUE TO CALCIPHYLAXIS
Authors: Scott Bolhack, MD; Shirley Grant, LPN; Barbara Viggiano, RN; Victoria Hensley, RN
BackgroundThe wounds due to calciphylaxis are challenging to heal. A literature search reveals
descriptions of these wounds but very little guidance related to the treatment.
Case ReportWe cared for a 67 year old female that developed nodular lesions subcutaneously
in her upper thighs. A reluctant surgeon performed surgery to remove these
nodules due to the pain they were causing. Subsequently, the healing process was
stalled and she presented to our wound center eight months after the surgery was
performed with multiple, painful, violaceous wounds. Debridements were limited due
to pain and lack of improvement in the wounds. In addition, multiple dressings were
attempted to close the lesions including antibiotic impregnated dressings, hydrofiber,
and honey-based products. Finally, a bioelectric dressing was used to treat the
wounds with success in both the closure of the wounds and for pain control (apart
from the healing process). The attached pictures demonstrate two of the lesions.
In the second lesion the patient choose to continue her own dressings in the home
setting until closure. Case management confirmed the closure of the wound.
DiscussionWounds due to calciphylaxis are due to the breakdown of skin from the calcification
of microscopic vessels. Treatment regimens for these wounds are not established.
Due to the underlying pathophysiology, debridement of the wounds may not
be helpful except to remove colonized devitalized tissue. Referral back to the
nephrologist to determine if hyperparathyroidism is being addressed or treated
is always warranted. This is the first case in which a bioelectric dressing, a novel
wound product with electrical activity, has been documented to work on wounds due
to calciphylaxis. Six months after closure of her wounds, she remained healed and
free from pain.
This was one of several non-surgical wounds that the patient developed from her calciphylaxis. Note the violaceous color on the skin in the surrounding area. This wound and local skin were very painful for the patient. In the second photograph, we have closure of the wound after four months. We were unable to debride adequately throughout this time period due to pain.
Wound OneThis original wound was a non-healing surgical wound that was open for several months before presenting to the wound center. Again note the violaceous skin. The time to healing was also very extended for this wound. She chose to continue the dressings in the home setting due to multiple health issues including dialysis.
Wound Two