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CLINICAL PROBLEM: 59-year-old male, with paraplegia from a gunshot incident years ago, developed a full thickness traumatic wound on the plantar surface of his left foot with joint involvement due to pressure from his wheelchair pedal. After being followed by a home care agency for two months with topical care and two surgical debridements, the surgeon had determined that the next course of action was amputation. The patient did not agree to this surgical option.
CURRENT CLINICAL APPROACH: A WOC referral was initiated. History of known sensitivity to silver products noted. No osteomyelitis upon x-ray. Strong distal pulses. The wound measured 4.5 x 4.5 x 1.5 cm. The wound base had a combination of necrotic yellow slough and granulation tissue. The toe joints could be probed with a sterile q-tip and were visible with a thin layer of granulation tissue. There was no odor, moderate amount of exudate, no peri wound maceration. After vigorous cleansing with wound cleanser[1], the wound was filled with a cadexomer iodine gel[2] and then covered with a topical dressing[3], which was changed twice per week. Strict offloading was enforced for pressure relief.
PATIENT OUTCOME: The wound base was free of necrotic tissue after four weeks. Wound measurements improved weekly, with closure achieved after twelve weeks.
CONCLUSION: Although the patient has no functional use of his leg or foot, he is grateful that limb salvage was achieved and an amputation was avoided. The cadexomer iodine gel2 removed debris, managed the exudate, and created an effective wound healing environment.
Financial Assistance/Disclosure: Smith & Nephew, Inc.
[1] Dermal Wound Cleanser®; Smith & Nephew Wound Management, St. Petersburg, Florida
[2] Iodosorb®; Smith & Nephew Wound Management, St. Petersburg, Florida
[3] CovrSite®; Smith & Nephew Wound Management, St. Petersburg, Florida