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Clinical Research
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Nonhealing traumatic lower extremity wound M. Ray Justice, BSN, RN, CWOCN, North Mississippi Medical Center Home Health, Tupelo, MS Sixty eight-year-old man admitted to nmmc home health agency after acute care hospitalization. Admitting diagnoses of cellulitis to LLE with gangrene, acute MI, pressure ulcer left heel, diabetes mellitus type 2, coronary artery disease, and anemia on 12/18/04. Trauma wound to posterior lle with dry non-draining eschar and non-stageable pressure ulcer to left heel. Conservative treatment initiated using betadine swab and dry gauze dressing daily due to poor peripheral circulation and poor surgical risk related to cardiovascular disease. On WOC nurse visit of 02/17/05, wounds to lle and lt heel were boggy and separated at edges with moderate serosanguinous drainage. Wound treatement changed to a hyper saline gauze dressing daily and performed conservative sharp wound debridement to both wounds on 03/09/05 that resulted in wound size of 12.5 cm x 5.5 cm x 1 cm depth with tendon visible. Treatment changed to a nanocrystalline silver gauze and on 03/31/05 initiated subatmospheric vacuum assisted wound therapy at 125 mm hg continuous therapy. On WOC nurse visit of 05/06/05 wound bed 100% beefy red granulation tissue 11cm x 4cm x 1cm depth. On WOC nurse visit of 07/01/05 wound measured 8.5 cm x 2 cm x 0.5 cm depth. On WOC nurse visit of 07/22/05 wound measured 7.5 cm x 1 cm x 0.3 cm depth. On WOC nurse visit of 08/05/05 wound now separated into two wounds with proximal measurement of 4.5 cm x 1cm and distal measurement of 1.8 cm x 1 cm and both now fully granulated. .Subatmospheric wound therapy discontinued and treatment changed to using a porcine small intestinal submucosa with a nanocrystalline silver gauze and was continuing until new admission to acute care for gangrene to right foot. |
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