"She was sent to our nursing home to die...or A Clinical Case Study in the Use of Silver Products to close a Recalcitrent wound"
Denise Howell, BA, RN, CRRN, CWOCN, St Catherine of Siena Nursing Home, Wound Specialist Nurse, 3 Willis Ave, Lake Ronkonkoma, NY 11779
The patient, a woman in her late 50's with severe rheumatoid arthritis with deformities and a history of multiple joint surgeries, was admitted to a teaching hospital after being diagnosed with a sacral stage IV pressure ulcer. The patient had been living independently at home and was becoming increasingly weaker, with a weight loss of approximately 100 lbs over the previous 6 months, when she developed a large area of eschar on her sacrum. The patient underwent 6 surgical debridements over a 2 month period, with concomitant treatment with negative pressure wound therapy, as well as endothermic wound treatments. The ulcer did not respond to this treatment and she was discharged to our skilled nursing facility for palliative care as she was told “you will die with this ulcer…it will never heal”. We put her on an air-fluidized bed for pressure off loading as she was basically immobile due to the severity of the RA and started her on negative pressure wound therapy using a silver foam dressing. The ulcer granulated 100% and then she was changed to hydrofiber dressings with silver. We kept her on the hydrofiber dressings with silver, until we had full re-epithelialization because her constant fecal incontinence kept contaminating the wound and it's dressing. When healing slowed, we added oxidized regenerated cellulose (ORC) and collagen to the regimen, and she was finally healed within 11 months. What was important here is that even when conventional negative pressure wound therapy dressings were utilized, this wound did not heal, despite having frequent surgical debridement of non-viable tissue. It was the use of silver wound dressings that finally enabled this wound to heal.