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Case Study
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Intremittent pressure and moist wound management for the treatment of complex, chronic, full-thickness wounds Gregory Eck OBJECTIVE: To illustrate the techniques used and results obtained utilizing Intermittent Pressure and Moist Wound Management Principles CASE DESCRIPTION: Patient is a 62-year-old woman who pre-morbidly had been an active, productive member of her community. July of 2004 she sustained a myocardial infarction and underwent a coronary artery bypass graft. Within 1 month she sustained a descending thoracic aortic dissection and underwent an axilofemoral bypass graft complicated by ventilator dependent respiratory failure resulting in ischemic spinal cord paraplegia. During her 6 months of ÒconvalescentsÓ in 5 facilities she developed 7 full thickness (fascia, tendon, muscle, capsule and bone exposed) non-healing post surgical and pressure wounds. Six were on the left lower extremity distal to the knee and one on the sacrum. Approximate tissue loss; superficially 400cm2; sub-dermally 450Ð500 cm2. She was also positive for methacillan resistant staphylococcus aureus and proteus mirabilis. Previous treatments: antibiotics, wet-to-dry, dry-to-dry, exposed to air/environment, saline gauze packing, occlusive dressing, negative pressure wound therapy and off-loading. She was deemed Ònot a candidate for flap graft closure of sacrumÓ and Òmost appropriate treatment for lower extremity is above the knee amputation.Ó The patient and family wanted no further surgical intervention. She was placed in an extended care unit on supportive care measures INTERVENTIONS: Treatment consisted of necrotic tissue and foreign body removal, followed by twice/day debridement/cleansing/irrigation, ultraviolet C, intermittent pressure (alternating pressure mattress), other physical modalities when appropriate and primary dressing with non-adherent pads under occlusive/semi-occlusive covering. RESULTS: At 5 months post implementation of intermittent pressure and moist wound treatment the wounds had progressed to allow patient to return to live with her husband. 8 months post implementation all wounds had completely epithelialized Conclusion: In this case a program consisting of Intermittent Pressure and Moist Wound Management brought these complex full thickness wounds to complete closure. |
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