Sustaining effective negative pressure therapy in patients with hyperhidrosis is frequently a challenge; one that was not easily addressed in this complex paraplegic patient. This 52 year old male, paraplegic, secondary hyperhidrosis, osteomyelitis, uncontrolled type 2 diabetes mellitus, hypoalbuminemia, severe protein-calorie malnutrition, neurogenic bladder, and urethral fistula, was admitted with septic shock and unstageable eschar covered ulcers involving the sacrum and right ischial tuberosity. Physician progress notes documented grave prognosis with little chance of wound healing or survival.
DESCRIPTION OF PAST MANAGEMENT
Initially the stage IV sacral ulcer was managed using surgical debridement and wet-to-dry dressings for one week without improvement. The wound care team was consulted and negative pressure was initiated on week two. However, the traditional negative pressure application using multiple trials of skin barrier products and compression garments failed to maintain dressing adherence, secondary to hyperhidrosis, for longer than a few hours.
CURRENT CLINICAL APPROACH
Although there is no published evidence to support any specific products that improve wound dressing adherence in hyperhidrosis, there are reports describing the use of aluminum-based antiperspirants in ameliorating the symptoms of secondary hyperhidrosis.1 Based on this limited evidence and anecdotal report of a colleague, an aluminum-based antiperspirant was trialed with application to a 3-inch peri-ulcer area, followed by benzoin, prior to securing the negative pressure therapy.
The addition of the antiperspirant as a skin prep has resulted in uninterrupted dressing adherence for up to 3-4 days at a time over an 8-week period. Despite improved protein-caloric intake and glucose control, malnutrition persists (albumin=1.7; pre-albumin=5); however, the sacral ulcer size has decreased from 24 x 16cm to 16 x 14 cm.
Exploring a nontraditional solution to control moisture due to hyperhidrosis played a critical role in management of this paraplegic’s stage IV sacral ulcer.