| 118 |
Case Study
|
Moist wound management: an alternative to grafting in a full-thickness neonatal wound Gregory Eck, Barron Medical Center, Barron, WI OBJECTIVE: To illustrate the effectiveness of proper wound bed preparation, bioburden and moisture management techniques in the treatment of a full thickness neonatal wound CASE DESCRIPTION: A 12-day-old male presents with a 16 cm2 desiccated full thickness wound over the dorsum of the left foot. Three family practice physicians and two general surgeons informed the parents that the only viable treatment was skin graft closure which the parents were opposed to due to the increased risk / trauma..I determined that this wound would heal without surgical intervention. INTERVENTIONS: Initial treatments focused on ÒsofteningÓ the eschar by applying a petrolatum based topical ointment covered with a non-adherent pad and occlusive dressing 3 times over the first 72 hours. This allowed complete removal of the Òmore pliableÓ eschar by sharp debridement with less disruption of the healthy underlying tissue during the fourth treatment session. Subsequent treatments consisted of mechanical / enzymatic debridement followed by dressing with a non-adherent pad and occlusive dressing. Every session concluded with 20Ð30 repetitions of full passive range of motion all planes of the ankle. The family also performed this (20Ð30 reps.) 3 times / day RESULTS: By treatment day 9 the wound had ÒbridgedÓ across the dorsum. By day 17 the medial one-third of the wound had epithelialized. By day 30 the entire wound bed re-epithelialized. The patient slept through 99% of the sessions; required no post treatment pain management; has full active range of motion and very minimal scar formation. CONCLUSION: Based on this case, proper wound bed preparation, moisture and bioburden management was a more appropriate; effective; efficient; less invasive; less traumatic; less expensive; highly under utilized treatment option compared to grafting for full thickness wounds particularly in the higher risk neonatal population. . |
|