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Case Study
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Combining wound care modalities Janet Davis, MSN, RN, APRN-BC, CWOCN, MD Anderson Cancer Center, Houston, TX Statement of Problem:.Numerous advanced wound management products/modalities are available to enhance and advance wound healing, and the practice of combining wound care modalities is not new, but has not been adequately or rigorously studied. Rationale:.Combined wound care therapies were utilized to expedite granulation, contraction, and epithelialization in preparation for a delayed surgical closure Methodology:.Initially, the wound required debridement to optimize a clean wound bed. Once the wound base had 25% or less necrosis, the wound care modalities utilized were papain-urea debriding ointment with chlorophyllin copper complex under NPWT. Over a span of 8 weeks, the wound granulated and contracted. The wound measured 13.5 x 9.5 x 3cm at the onset of the combined treatment. By the end of 8 weeks, the wound measurements were 9 x 4 x 1.5cm. The reduction in wound length was over 67%, width reduction was 42% and the depth decreased by 50% At the end of 8 weeks, the wound produced an odor and cadexomer iodine products were used under NPWT to decrease the bacterial load to prevent regional wound and systemic infection. The wound base continued granulating, contracting and epithelializing until a delayed surgical closure was accomplished Results:.Using a variety of wound care modalities provided a synergistic effect in granulating the wound base and preparing the patient for surgical closure Conclusion:.Combining methods/therapies can provide better symptom control and a synergistic effect of promoting orderly wound healing by promoting faster granulation and wound contraction. Argenta LC, Morykwas MJ. Vacuum-assisted closure: a new method for wound control and treatment: clinical experience. Ann Plast Surg. 1997;(38)6:563Ð576 Ford CN, Reinhard ER, Yeh D, et al. Interim analysis of a prospective, randomized trial of vacuum-assisted closure versus the Healthpoint system in the management of pressure ulcers. Ann Plast Surg. 2002;49(1):55Ð31 Melano E, Rodriquez HL, Carrillo R, Dillion L. The effects of Panafil when using topical negative pressure to heal an infected sternal wound. J Wound Care. 2004;13(10):425Ð426. Niezgoda JA. Combining negative pressure wound therapy with other wound management modalities. Ostomy Wound Manage. 2005:51(suppl 2A):36SÐ38S Schoemann MB. Treating surgical wound dehiscence with negative pressure dressings. Ostomy Wound Manage. 2005;51(suppl 2A):15SÐ20S Wu SH, Zecha PJ, Feitz R, Hovius SER. Vacuum therapy as an intermediate phase in wound closure: a clinical experience. Eur J Plast Surg. 2000;23:174Ð177 Wound Bed Preparation for Optimal Use of Advanced Therapeutic Products. Available at: http://www.bu.edu/woundbiotech/woundcare/Woundbedpr.html. Accessed: June 23, 2005. |
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