OBJECTIVE

Complex challenging wounds of various etiologies are managed at our Wound Care Clinic. Identification of causative factors, surgical and sharp debridement, use of medications, compression and off-loading along with adjunctive therapies and education are all part of our holistic approach in developing comprehensive treatment plans.1 Effective treatment plans are often determined by the right combination of topical dressings and adjunctive therapies.2

HOLISTIC APPROACH: ADVANCED WOUND PRODUCT SELECTION FOR THE MANAGEMENT OF PATIENTS WITH COMPLEX CHALLENGING WOUNDS

Dimitrios Lintzeris, DO, CWS; Kari Yarrow, RN; Laura Johnson, RN; Amber White, RN; Amanda Hampton, RN; Kristy Albert, PTA; Arlene Cook, PTA; Anthony Strickland, RNWayne Memorial Wound Care Center, Goldsboro, NC

RESULTS

It is evident that even with the varied population, wound types and co-morbidities a common outcome was the reduction in wound surface areas by 25% in just 2 weeks after the addition of one or more of ALH, LH HCS, SAP, TCC or compression. All 5 patients were treated with ALH combined with SAP. However, the 2 patients that had the addition of compression and the 1 patient that had the addition of TCC achieved closure in 59 days or less.

CONCLUSIONS

All of the wounds demonstrated progress achieving complete closure in an average of 59 days. All of the patients were pleased with the improvement in their wounds.

METHOD

This patient case series focuses on topical wound care and off-loading, in particular; 5 patients using Active Leptospermum Honey (ALH)*. In addition, 3 patients also used a novel Super Absorbent Polymer Dressing (SAP)** 2, patients were concurrently treated with compression therapy and 1 patient used off-loading with total contact casting (TCC)**** 3. Patients were chosen due to chronicity of wounds with lack of healing progress in 1 month to 6 months despite use of other advanced methods of treatment; including but not limited to collagen, skin substitutes, silver dressings and enzymatic debriding agents. Patients were medically complex with multiple co-morbidities and history of non-adherence to medical advice impacting healing.

References: 1. A. Barbul et al. Clinical Treatment Guidelines, Wound Repair and Regeneration 2006; 14: 645-711. 2. Healogics Inc., Jacksonville, FL Clinical Practice Guidelines (CPG) 2013. 3. C. Fife, MD; Marissa J.Carter, PhD, MA; David Walker, CHT; Wound Repair and Regeneration 2010; 18: 154-158

CASE 1Case Discussion: 56 year old male presented with a left Hallux postsurgical wound and a left 2nd toe amputation site.

PMH includes: sleep apnea, cataracts, kidney stone, chronic pain syndrome, and carpal tunnel syndrome. Patient was treated with ALH Gel to the wound bed daily. On 6/26/13 evaluation wound was 100% closed.

Patient Outcomes: 48 Days to 100% closure

5/9/13

6/27/13

1/2/13

1/2/13

5/20/13

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7/4/13

2/14/13

2/14/13

5/28/13

5/22/13

7/18/13

3/6/13

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7/25 /13

5/21/13

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8/113

7/3/13

7/3/13

Derma Sciences provided an educational grant to support this research. The information may include a use that has not been approved or cleared by the Food and Drug Administration. This information is not being presented on behalf of Derma Sciences.

*MEDIHONEY® Active Leptospermum Honey Dressings, Derma Sciences Inc., Princeton, NJ**XTRASORB® Super Absorbent Dressings, Derma Sciences Inc., Princeton, NJ***MEDIHONEY® Leptospermum Honey HCS Dressings, Derma Sciences Inc., Princeton, NJ****TCC-EZ® Total Contact Cast System, Derma Sciences Inc., Princeton, NJ. *****Acticoat, Smith & Nephew, London UK******Coban 2 lite,3M, St. Paul, MN******Prisma, Systogenix, Gatwick, West Sussex, UK *******Santyl, Healthpoint, Fort Worth, TX

CASE 3Case Discussion: 85 year old male, presented with a long standing history of an a traumatic open wound of the lower leg.

PMH: HTN, diabetes, CAD, osteoarthritis, depression, atrial fibrillation and chronic anticoagulation. ABI and ankle pressures are suggestive of mild arterial disease.

Patient was treated weekly with selective sharp debridement; ALH Gel, SAP and a 2 layer compression wrap.

Patient Outcomes: 35 Days to 100% closure

CASE 4Case Discussion: 82 year old male presented with an ulcer of the right great toe which the patient was treating at home for two months prior.

PMH: HTN, GERD, heart attack, hyperlipidemia, and stroke

Silver Collagen dressing****** was initiated until further tests were evaluated such as Hgb A1C and x-ray. Hgb A1C was 7.9 and x-ray negative for osteo mellitus. Started the patient on ALH Alginate, foam, and TCC. Patient was seen weekly for debridement and cast change. 3/21 wound was 100% healed and patient was transferred to ortho wedge shoe while custom inserts and extra depth shoes were prepared.

Patient Outcomes: 42 Days to 100% closure

CASE 5Case Discussion: 79 year old male presented with a gangrenous right toe. Amputation of the affected toe and 1st metatarsal head was performed.

PMH: Traumatic brain injury secondary to gunshot, HTN, BPH, osteomyelitis, PAD, and diabetes mellitus. Patient is a smoker.

1/25/13 to 2/21/13 patient treated with collagenase and Negative Pressure Wound therapy (NPWT). From 2/28/13 to 7/26/13, patient was treated with ALH gel and gauze roll every 48 hours.

Patient Outcomes: 147 Days to 100% closure

CASE 2Case Discussion: 60 year old male presented with blistering ulcers of the right lower leg.

PMH includes: Diabetes mellitus and hypertension. There was significant erythema to the leg, drainage is heavy, yellow, without significant malodor. Patient was treated with a silver dressing*****, SAP, Tubigrip or 2 layer compression dressing******. Upon complete closure of wounds, patient was advanced to 20-30mm hg compression hose.

Patient Outcomes: 24 Days to 100% closure

Presented at SAWC Spring 2014, Orlando, FL

0668709-1-EN