Abstract: A Sweet Solution to a Bitter Life Problem: The Use of Active Leptospermum Honey Wound and Burn Dressing in a Lower Extremity Chronic Lymphedema Patient: A Case Study (44th Annual Conference (June 9-13, 2012))

Argelia Welber, RN, BSN, CWOCN, CMSRN¹, Mehrdad M. Farid, M.D., R.V.T.², Carmel A. Celestin, M.D., F.S.V.M.² and Bernardo B. Fernandez, M.D., F.A.C.P.³, (1)Cleveland Clinic Florida, Wound Care Nurse Clinician, Department of Vascular Medicine, Weston, FL, (2)Cleveland Clinic Florida, Physician, Weston, FL, (3)Cleveland Clinic Florida, Department Chair, C.E.O., Cleveland Clinic Florida, Weston, FL

Chronic lower extremity (LE) lymphedema is a devastating disease due to multiple issues including cosmetic disfigurement and difficulty managing malodorous drainage. The cost of care burdens its victims. Lymphedema has been a neglected topic in WOCN practice but merits attention. In our clinic these challenging cases require a team approach.

A 42 year old morbidly obese male presented with a 15 year history of stage III LE lymphedema and a recent 3 month history of copious malodorous drainage. Multiple co-morbidities included IDDM, kidney disease (Stage IV), hypertension, anemia, and polypharmacy which delayed healing. Multiple sites of care affected communication.

Previous management included antifungals, silver hydrofiber dressings, absorbent pads, rolled gauze and elastic bandages. The quantities required led to out of pocket expenses over $300 weekly. Extensive maceration, denudement and uncontrolled drainage persisted. The goals of care were to identify cost-effective dressings that controlled exudate and odor. This led to a team approach and a new topical dressing plan including Active Leptospermum Honey (ALH). ALH was chosen due to multiple mechanisms of actions including control of bacteria and increased length of activity requiring less dressing changes. Coordination with family providing dressing changes, outside facility for Manual Lymphatic Drainage and Complex Decongestive Therapy, and plans for Intermittent Compression Therapy promised improvement.

In two months, LE condition began to improve despite hospital admission and complicating factors. Using ALH eliminated odor, improved skin condition and patient’s self-esteem by the third month of care. Decreased frequency of changes and control of exudate reduced costs to less than $90 weekly.

Although limited to one case, this has been a learning experience with goals achieved and positive outcomes. ALH has added to the armamentarium of wound care choices as a first line option for patients with similar conditions. A larger randomized trial is recommended to substantiate observations.

6106 A Sweet Solution to a Bitter Life Problem: The Use of Active Leptospermum Honey Wound and Burn Dressing in a Lower Extremity Chronic Lymphedema Patient: A Case Study