A new method for managing fasciotomy & other complex wounds and the WOC nurse

Statement of Clinical Problem: Fasciotomy wounds are painful and challenging wounds for the WOC clinician to manage. Current clinical management in the author’s organization has been negative pressure wound therapy followed by split thickness skin graft or primary closure once edema has decreased and muscle tissue is covered with a granulation tissue base.

Description of Past Management: Prior to this, options for management included wet to dry normal saline dressings or negative pressure wound therapy and skin grafting.  Both are associated with pain, high costs and possible prolonged time to wound closure.

Current Clinical Approach: Use of the continuous external tissue expander, with or without negative pressure wound therapy, is a newer and successful approach to managing these wounds .It promotes healing by exerting a continuous pulling force with a spring tension motor to gradually stretch the skin.  Careful monitoring and effective management leads to positive patient outcomes. Wound care, pain management, frequent neurovascular and skin assessment, patient education and monitoring for dislodgement, or peri-wound tissue ischemia and necrosis are priority nursing measures.  The WOC Nurse can play a significant role in patient and staff education regarding management of wounds with this device.

Patient Outcomes:  In the patients described, this is a well-tolerated therapy that  can shorten  healing time, decrease risk of wound complications, decrease costs and pain, and  improves patient satisfaction. The need for skin grafts is reduced or eliminated.

Conclusions:  Clinical outcomes in these cases resulted in decreased time to wound closure, decreased costs and pain, reduced scarring and improved cosmesis,