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CLINICAL PROBLEM: 74-year-old male, retired physician, with deformities of the lower legs and feet from polio. History of left-sided stroke. He lives at home and has paid caregivers during the day. Non ambulatory, he wears a brace on the right leg and sits in a scooter most of the day with his feet dependent. While in his scooter, he sustained a significant traumatic wound on his right anterior upper leg by colliding with a metal bed frame. There is a high volume of exudate and odor present. The wound is positive for MRSA. The patient desired an alternative to surgical intervention. Current acetic acid dressings cause burning.
CURRENT CLINICAL APPROACH: The wound measured 13.0 x 23.0 x 2.0 cm, base with scattered necrotic slough, especially at margins. The wound was cleansed with a Dermal wound cleanser[1], and dressed with a silver calcium alginate dressing[2]. The dressing was changed every three days and as needed for exudate management.
PATIENT OUTCOME: The wound measurements improved weekly to the point of closure within six months. The dressing was highly absorptive and effective for bacterial and odor control. No burning or discomfort. Surgical intervention was avoided.
CONCLUSION: The silver calcium alginate dressing provided an optimal wound healing environment. It controlled exudate, eliminated bacteria, conformed well to the wound base, and was easy to apply and remove. Necrotic debris was eliminated, odor was controlled and eliminated, and it promoted granulation tissue to the point of wound closure without surgical intervention.
Financial Assistance/Disclosure: Smith & Nephew, Inc.