PROBLEM 87-year-old female with dementia, poorly controlled diabetes, immobility, hypertension and recurrent diarrhea in long-term-care facility following right hip fracture with stage II sacral/coccyx pressure ulcer. Hydrocolloid dressing changed every 3 days and PRN. Improved first 8 weeks, then deteriorated: developed perineal candidiasis with satellite lesions and periwound erythema, ulcer larger with yellow film over wound bed. Avascular wound 2.4cm long x1.4cm wide x0.4cm deep, macerated edges. Pain only during treatment.

RATIONALE Polymeric membrane dressings reduce wound pain and inhibit infection while donating or absorbing moisture as needed. Ingredients draw and concentrate healing substances from body into wound bed to promote rapid healing while facilitating autolytic debridement directly by loosening bonds between slough and wound. Liquefied slough absorbed by dressing, often eliminating need for cleansing during dressing changes. Infection was a serious concern. Silver polymeric membrane dressings have antimicrobial properties. Therefore, silver polymeric membrane dressings were initiated.

METHODOLOGY Wound bed flushed with normal saline and silver polymeric membrane sacral bordered dressing applied. No further cleansing unless wound contaminated with stool. Dressings changed every three days. Patient is repositioned every two hours, avoiding pressure area.

RESULTS Case is ongoing. Significant improvement after only 48 hours, with autolytic debridement already occurring. At two weeks, wound was 1.5cm x 0.5cm x 0.2cm deep with 30% epithelization, 70% granulation tissue, no maceration.

CONCLUSION As soon as a silver polymeric membrane sacral bordered dressing applied, wound began healing instead of continuing to deteriorate. Dressing changes are very time efficient – just remove old dressing and apply new one. Further conclusions may be drawn when case study is completed.