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Case Study
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Futility versus opportunity when treating long-standing chronic wounds Jeffrey A. Niezgoda, MD, FACHM, FACEP, Mary Verhage, RN, BSN, CWOCN What factors determine the point at which the wound care clinician deems advanced wound care interventions to be futile? When does the person with a chronic wound no longer benefit from aggressive care? There is a distinction between exhausting a clinicianÕs toolbox or Òbag of tricksÓ to treat a complex long-standing wound and the issue of futile care This case study presents the story of a 60-year-young active, productive woman who had suffered the burden of a non-healing circumferential lower leg wound for nine years. An injury at the age of 51 was the catalyst. She sought consultation and interventions from multiple wound care centers only to have the multitude of interventions succeed for short periods of time but eventually fail. At the age of 60 her primary care physician told her to resign herself to living with the open wound for the rest of her life. That option placed her at risk for repeated infections, sepsis, and loss of limb or life. Over nine years, she was diagnosed with a resistant pseudomonal infection, osteomyelitis, and mixed arterial and venous disease. Interventions included split thickness skin grafts x 2, aggressive antibiotic regimens (IV and oral), Unna's boot compression, and wet to dry acetic acid gauze dressings When admitted to acute care with a DVT and cellulitis, a referral for advanced wound care was written. A multidisciplinary group of health care professionals collaborated to provide a series of treatments that ultimately lead to complete wound closure with a substantial f/u time demonstrating durability The multidisciplinary approach included an Infectious Disease specialist, Orthopedic surgeon, Plastic surgeon, Advanced Wound Care and Hyperbaric Medicine physicians, and nursing. The unique interventions included bone biopsy/debridement, targeted antibiotic therapy, negative pressure wound therapy, antimicrobial silver cloth dressings, split thickness skin grafting complimented by platelet gel therapy, and hyperbaric medicine. . Carson SN, et al. Vacuum assisted closure used for healing chronic wound and skin grafts in the lower extremities. Ostomy Wound Manage. 2004;50(3) 52Ð58 Demling R, DeSanti L. Effect of sliver on wound management. WOUNDS. 2001:13;11Ð19. |
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