PROBLEM 49 year-old-male quadriplegic with chronic non-healing sacral pressure ulcer, frequent UTIs, depression, Hepatitis C, and GERD had ulcer surgically debrided. To rehab with 7cmx5cmx2.5cm ulcer with 4cm undermining 1–5 o'clock; 50% pink tissues, 35% slough, 15% eschar, draining moderate amount serosanguineous. L-arginine supplement for low protein. Treatment: ¼ strength Dakin's wet-to-dry twice/day. Later: alternated with saline wet-to-dry. Goal: fully granulate over exposed bone, decrease undermining → permit surgical closure. After two months, wound cleaner (75% granulation), same size. Still stage IV, exposed bone. 4cm undermining:1-6 o'clock. Periwound skin macerated.

RATIONALE Polymeric membrane dressings' ingredients draw and concentrate the body's healing substances into wound bed to promote rapid healing while loosening bonds between slough and wound. Able to hydrate wounds while absorbing excess fluid, so recommended for dry (exposed tendons and bones) as well as heavily exudating wounds. Silver polymeric membrane dressings have antimicrobial properties. Wound filler form, without backing, allows all surfaces to absorb/transfer fluid. Therefore, silver polymeric membrane wound filler initiated.

METHODOLOGY Silver polymeric membrane wound filler placed in contact with entire wound bed. Cavity lightly filled with gauze 4x4's, covered with polymeric membrane sacral border dressing, changed every 3 days. After wound filling in, outer dressings changed to extra-thick polymeric membrane dressing, changed every two days because of increased exudate.

RESULTS Immediately, undermining decreasing, tissue forming over exposed bone, maceration resolving. At two weeks: 95% granulation tissue, 0.5 cm shallower, no exposed bone! Fourth week: fully granulating with 3cm undermining – admitted for surgical closure (successful).

CONCLUSION Clinician had not used polymeric membrane dressings before. Change in wound with switch to silver polymeric membrane wound filler dramatic. Very little progress in previous two months. Using polymeric membrane dressings, suddenly wound filled in. Ready for surgical closure in only 25 days.