Wounds with Limb Threatening Hematomas and Necrosis Successfully Managed with Polymeric Membrane Dressings

Clinical Problem: Patient 1, a 71 yr old immobile female with dementia and hypertension fell and sustained knee and lower leg trauma with accompanying extensive deep tissue hematoma. The 80% necrotic wound was 9cm x 5 cm x 4cm with 4 cm of undermining. Patient  2, a 79 yr old immobile, hypertensive female suffered full thickness 18cm x 9cm  dermal necrosis of right forearm over hematoma resulting from anticoagulant therapy as well as a 5cm x 4.5 cm left lower leg necrosis as a result of thrombosis.  Patient 3, a 93 yr old  hypertensive female suffering with dementia experienced left brachial arterial occlusion secondary to a cardiovascular accident, the resulting full thickness wound was 22 cm x 5cm.

Past Management: Patient 1’s wound was initially managed with triple antibiotic covered with gauze and wrapped in stretch gauze over the sutures. Patient 2’s wounds were managed from initiation with polymeric membrane dressings. Patient 3’s wound was initially managed with silver sulfadiazine ointment covered with gauze.

Current clinical Approach: All wounds were either initially or subsequesntly managed with polymeric membrane silver rope in tunnels and undermined areas. The rope dressings were covered with polymeric membrane dressings.

Patient Outcomes: The placement of the polymeric membrane silver rope into the hematomas resulted in rapid liquefaction of the hematomas. This rapid reduction of the hematomas resulted in dramatic increase in the patients comfort. Patient 1 went on to complete wound closure. Patient 2 died a few days after dressings initiated due to refusal of surgery to clear colostomy occlusion. Patient 3’s wound went to almost complete closure before the patient died from another cardio vascular accident.  Conclusion: In these example cases, the dressings improved patient comfort while rapidly facilitating the resolution of the hematomas and necrosis.