To evaluate the clinical performance, healing rates, and autolytic debridement effects of a polyurethane foam dressing (PFD) versus alginate on heavily exudating wounds on contralateral lower extremities in one subject.
A 51 y/o male, obese, diabetic was admitted for infected lower extremity ulcers. He underwent operative debridement and fascial exploration for necrotizing fasciitis, was treated with Vancomycin IV, and left to heal by secondary intention. CT showed osteomyelitis of the terminal tuft of the left second toe. He was referred to the author's clinic for management of the ulcers.
The patient had multiple leg and foot ulcers involving skin, subcutaneous tissue, fascia, and muscle. The ulcer on dorsum of the left foot measured 118 cm2; the right foot ulcer measured 168 cm2. Both ulcers had large exudates, with undermining, 80% slough, and exposed tendon.
Sharp debridements were done weekly. PFD was applied to left foot ulcer, and an enzymatic debrider with alginate was applied to the right foot ulcer. The ulcers were assessed at every dressing change, which was done every 3-5 days.
Over 12 visits, PFD rated better than alginate in regard to ease of dressing removal and application, absorbability, conformability, pain, and periwound condition. The ulcer treated with PFD showed >40% size decrease and 40% increased granulation. The ulcer treated with enzymatic debrider and alginate showed a 15% size reduction and 40% increased granulation.
Polyurethane foam dressings absorb excess exudate while maintaining a moist environment, facilitate autolytic debridement and healing, and improve patient quality of life.
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