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CLINICAL PROBLEM ; 67 year old obese female with lymphedema, congestive heart failure, atrial fibrillation, diabetes type 2, bilateral fractured femurs with intramedullary rod insertions, chronic perineal candidiasis. Patient has had R lower extremity venous ulcers for 6 years duration. Wounds were enlarging and becoming increasing painful. Patient is bedbound and relies on her spouse for total care. Wound cultures taken were positive for a variety of bacterial infections including Klebsiella pneumonia, pseudomonas, MRSA, and E-Coli. Each infection was treated aggressively with IV antibiotics.
DESCRIPTION OF PAST MANAGEMENT- The primary treatment for this patient has been four-layer compression bandages. Under the 4 layering system, both regular and silver, foams, alginates, and collagen wound dressings were utilized. With each dressing intervention patient wounds began to hypergranulate accompanied with increasing pain. Excessive bleeding and hypergranulation was a frequent problem which was treated with topical treatments of Silver Nitrate. Ketorolac, acetaminophen/hydrocodone and hydromorphone was given for pain relief.
CLINICAL APPROACH-After numerous wound care treatments Active Leptospermun Honey was applied. Initially the honey created an osmotic pool with increased drainage. Honey was applied in an alginate dressing, wrapped with gauze. An ace bandage was applied over the dressing. Dressings were changed twice a week.
PATIENT OUTCOME- The size of the wound and the hypergranulation of tissues began to subside. Eventually all the pain stopped and patient was able to discontinue all of her pain medications. Wound size decreased by over 80% in a six month period. Wound cultures were not retaken as it was considered unnecessary. Patient is encouraged and hopes to see total wound closure in the near future.
Nancy Chaiken ANP-C CWOCN