Special Case Study on a Left Thumb and Distal Wrist with the Use of An Extracellular Matrix-Porcine Derived Wound Product

CRITICAL PROBLEM: A mid 30’s - white female with quadriplegia status post gunshot wound in 2001, has sustained an IV infiltrate skin lesion while at another acute care hospital that developed necrotic eschar of Left thumb thenar eminence and distal wrist.  Patient is unresponsive due to recent hospitalization involving multiple stroke and sepsis, has been ventilator dependent.  Nurses on the admitting unit were apprehensive to initiate interventions involving patient’s Left hand as the necrotic area on the L thumb served as a threat and that it will fall off at the slightest movement of the hand.  Physicians from referring hospital believed that the L thumb will need amputation due to necrosis. DESCRIPTION OF PAST MANAGEMENT: Mafenide acetate cream application that forms like a slurry over saline moistened gauze has been initiated from the time of admission for five weeks as patient had no treatment ordered while at another hospital. Treatment included once a week conservative sharps debridement. After five weeks of weekly conservative sharps debridement and use of Mafenide Acetate Cream, wound has been noted with epithelial tissues on wound margins, granulation tissues and exposed tendon in wound bed. CLINICAL APPROACH:  Application of the extracellular matrix based wound product comprised of porcine-derived acellular small intestine submucosa to the L thumb thenar eminence extending to the distal wrist.  This wound product has been re-applied each week and left intact after each application for one week with sharps debridement as needed.  OUTCOMES: After four weeks use of the porcine derived wound product, L thumb thenar eminence and L distal wrist has been noted with epithelialization, and was declared fully healed 14 weeks after admission. CONCLUSION: Optimal patient outcomes, L thumb thenar eminence and distal wrist has been salvaged and did not require amputation.