Use of High Volt Pulsed Current on a Stage IV Sacral Wound in a Medically Complex Spinal Cord Patient-A Case Study

JB is a 16-year-old male who sustained a T6 traumatic spinal cord injury (SCI) from a gunshot wound.  Due to a significant acute hospital course, he developed a Stage IV sacral wound. He was admitted to our SCI rehabilitation facility with the wound measuring 7x4.4x3cm with observable slough and thick yellow drainage.  A satellite wound of 4.5x1.5 cm was noted.  High volt pulsed current (HVPC) was deemed appropriate and provided one to two times per day, 5 days per week, until the wound resolved. 
JB was positioned in prone for HVPC and the electrode was fashioned out of aluminum foil for optimal sizing.  The wound was gently packed with saline soaked gauze and the patient was treated for 60 minutes per session. The wound was re-evaluated by the treating team every week. Within 28 days, the wound measured 4x 2.4 cm and the satellite wound measured 0.3x0.3 cm.  The wound was fully resolved prior to his discharge date 45 days later.

The key aspects of this case include permission by JB’s private insurance company to stay in acute inpatient rehabilitation specifically for the HVPC after he achieved his acute rehabilitation goals.  The team gave weekly measurements for the company to assess his progress and would grant extra time for him to stay based on his progress.  JB’s compliance was critical with his sitting schedule, returning to bed and coming to the clinic before open hours for HVPC treatment.  Lastly, the combination of medical, nursing physical and occupational therapy expertise and teamwork, allowed this patient’s Stage IV sacral wound to heal and to avoid surgical intervention.  
JB’s insurance company avoided costly surgical intervention by allowing him to stay in acute rehabilitation.  The team concept and communication with the stakeholder facilitated short-term investment for long-term benefit.