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CLINICAL PROBLEM: 67-year-old female, with a severe Charcot deformity of the right foot; chronic ulcer on the lateral ankle. She had a history of diabetes and peripheral neuropathy. There was a strong pedal pulse. Previous skin grafting attempts and the use of advanced wound products failed to close the wound within one year. In order to prepare the wound for another skin graft and corrective orthopedic surgery, the current treatment included negative pressure wound therapy. The peri wound area had erythema, maceration, was subject to further trauma/injury, and the wound bed had no depth. This resulted in the components of the NPWT system not being contained on the base of the wound.
CURRENT CLINICAL APPROACH: The wound measured 3.0 cm round. After wound cleansing, a pattern that was 1.0 cm larger than the wound dimension was traced and cut in the middle of the absorbent silver barrier dressing[2], then centered over the wound. A bead of ostomy paste was used to seal the inner pattern of the cut foam dressing, to ensure that the negative pressure did not incorporate in the wound dressing system. The NPWT system was applied per procedure and changed twice per week. Strict offloading was enforced for pressure relief. Blood sugars were controlled within normal range.
PATIENT OUTCOME: The erythema in the peri wound area resolved, and the maceration decreased. The gauze and tubing of the NPWT were contained within the wound bed. Within one month, the wound was ready for surgery.
CONCLUSION: The use of an absorbent silver barrier dressing provided an antimicrobial barrier, decreased maceration, provided protection against further injury and was a successful way to manage the NPWT system.
Financial Assistance/Disclosure: Smith & Nephew, Inc.