Use of a silver wound cleanser on an infected BKA

USE OF A SILVER WOUND CLEANSER IN HEALING AN INFECTED BKA

               An 81 year old patient transferred to our hospital with a non-healing BKA.  He had undergone 41 sharp surgical debridements and was  debilitated on admission.  His history included NIDDM, PVD, and CAD.  On examination his left BKA had exposed bone, foul odor, and green exudate.  Labs indicated an elevated blood glucose level, low serum albumin, and an elevated WBC.  He was experiencing unremitting pain in the affected stump.

               Initial care included daily cleansing with a silver impregnated wound cleanser, a hydrogel dressing, IV antibiotics, nutritional supplements, and pain medication.  As the infection cleared the pain became more manageable.  After several weeks the patient was transferred to the in-house rehab unit and began strength training and learning how to master ADLs.  As the infection resolved the patient’s pain was better controlled and he began to function well and cope with his BKA.  Soon he was able to ambulate with a walker, transfer to the wheelchair, and perform ADLs. 

               The pseudomonas infection to the BKA was resolved during his stay in rehab and NPWT was applied to promote granulation.  At that point the patient was discharged home with the wound vac and was seen weekly in the out-patient clinic for dressing changes.  As before the silver impregnated wound cleanser was used with every dressing change.  During this time the patient began to have a social life again after two years of being an invalid.  He went out for meals and gatherings of friends and family with his wife at his side.   Hydrogel dressings were used after NPWT was discontinued and the stump subsequently went on to heal.