PROBLEM Healthy 54-year-old man fell off bluff, severely injuring left ankle. After multiple surgeries including application of pins and screws, twice-a-day saline wet-to-dry dressings followed by negative pressure therapy three times/week, dismissed to outpatient wound care 24 days post-injury with 3.5cm long x 13.5cm wide x 0.5cm deep open wound with two areas of exposed tendon and an adjacent intact suture line. Periwound skin edematous, erythematous, discolored; partially granulating wound draining large amounts serous fluid. Goal: reduce exudate, cover tendons → split-thickness skin grafting. Negative pressure therapy somewhat helpful in hospital but could not be continued out-patient. Patient states pain only during treatment.

RATIONALE Integral components of polymeric membrane dressings work together to create an ideal moist environment, concentrating the body's natural healing nutrients by absorbing watery portion of wound fluid. These unique dressings soothe and hydrate dry wounds while absorbing excess wound fluid, so they are recommended for dry wounds including exposed tendons and bones as well as for heavily exudating wounds. Polymeric membrane dressings available in extra-thick version for extra absorbency. Since wound had exposed tendon areas but was highly exudating, extra thick polymeric membrane dressings initiated.

METHODOLOGY Patient instructed to elevate leg; given nutrition supplements and preventative oral antibiotics. Extra thick polymeric membrane dressings applied directly to the wound; changed twice/week.

RESULTS/CONCLUSION Case is ongoing. After one week of thick polymeric membrane dressing use, wound already decreasing in size, at 3.0cm long x13.0cm wide x0.5cm deep with significantly less edema. Tendons partially covered and viable. Patient's split-thickness skin graft scheduled for ten days after initiation of extra thick polymeric membrane dressings.

*PolyMem^® Max^TM Wound Dressings, Ferris Mfg. Corp., Burr Ridge, IL 60527