Management of Complex Congential Wounds

Topic: Management of Complex Congenital Wound

Statement of Clinical Problem: While some congenital skin abnormalities in infants and neonates can be managed surgically, others require advanced wound care. In providing such care, the CWOCN can assist in increasing quality of life, minimizing pain with dressing changes, preventing infection, and decreasing or delaying the need for surgical intervention.

5 neonatal patient cases will be presented:

1. Cutis aplasia
   1. Past Management (PM): silver sulfadiazine cream,  frequent dressing changes
   2. Current Approach (CA): 24-72 hour dressing change using multiple treatment modalities, including silver hydrogel, medical grade honey, silver-impregnated hydrofiber, and soft silicone dressings
   3. Outcome: greater than 50% reduction in size, no secondary infections, followed outpatient
2. Amniotic bands
   1. PM: leave open to air
   2. CA: medical grade honey and soft silicone dressings daily
   3. Outcome: surgery avoided, no secondary infections, follow-up no longer needed
3. Thrombus
   1. PM: wet-to-dry, 2-4 times per day
   2. CA: silver hydrofiber and cover dressing daily
   3. Outcome: surgery avoided, no secondary infections, managed outpatient, CWCN received award
4. Large abdominal wall defect
   1. PM: petrolatum gauze changed 2-4 times per day, negative pressure wound therapy (sedation required)
   2. CA: sheet hydrogel daily, advanced to silver hydrofiber and soft silicone dressing twice per week
   3. Outcome: no secondary infections, monthly follow-up, no pain with dressing changes
5. Bart Syndrome
   1. PM: petrolatum gauze twice daily
   2. CA: collaboration with pain team, multiple advanced wound care modalities
   3. Outcome: surgery avoided, secondary infection treated, managed at home

Conclusions: While biologic dressings may be beneficial, these were not available. However, in these instances, the wound care specialist’s unique skills set, critical thinking, and evidence-based practice decreased painful dressing changes, promoted healing, and increased quality of life in neonates and infants born with congenital skin malformations.