![[ Visit WOCN Website ]](images/banner.jpg)
CLINICAL PROBLEM: 93-year-old male, with recent right hip fracture and repair, admitted to skilled unit for rehabilitation, sustained bilateral pressure ulcers on heels. Left heel with Stage II, fluid filled blister. Right heel with Unstageable pressure ulcer, base covered with necrotic eschar, soft and mushy. Staff reported odor, maceration and frequent dressing changes with use of various topical dressings, including square foam. Challenge had been to find a dressing that would conform to the heel, durable, sustain walking regimen, showering twice a week, decrease maceration and odor, and promote healing.
CURRENT CLINICAL APPROACH: The left heel wound measured 2.0 x 2.0 cm. The right heel wound measured 5.0 x 4.0 cm. The wounds were cleansed with a Dermal wound cleanser[1], and dressed with silicone bordered shaped dressings[2]. Pressure relief by elevation.
PATIENT OUTCOME: The dressings were changed weekly, and were waterproof for showering. They conformed to the anatomy of the heel and were comfortable. They absorbed unwanted exudate and cellular debris. Ambulation and dressing changes were comfortable and without pain. The blister remained intact without rupture. The left heel wound resolved in two months, the right in three.
CONCLUSION: The silicone bordered shaped dressings provided an optimal wound healing environment for these bilateral heel pressure ulcers. The shapes provided for a longer wear time as compared to other foam dressings and were waterproof. The blister was protected without rupture. The eschar dried and was able to be debrided with sharp sterile instruments with intact skin underneath. The patient was able to ambulate without pain.
Financial Assistance/Disclosure: Smith & Nephew, Inc.
[1] Dermal Wound Cleanser®, Smith and Nephew Wound Management, St. Petersburg, Florida.
[2] Alleyvn Gentle Border Heel ®, Smith and Nephew Wound Management, St. Petersburg, Florida.