Resolving Epibole with Polymeric Membrane Dressings in Home Care

Resolving Epibole with Polymeric Membrane Dressings in Home Care

Clinical Problem

During wound healing, full thickness wounds may become chronic due to closed or rolled non-proliferative wound edges. This condition is known as epibole.  Generally, epibole is treated via surgical excision or chemical cauterization. For the homebound patient, these treatments are not always a viable option due to limitations of: accessibility, tolerance, affordability, or comorbidities.  Three case studies will be presented:  a 62 year old female with dehisced surgical wound, 58 year old female with pressure ulceration, and a 53 year old female with surgical wound. 

Past Management

Patients’ past treatments ranged from daily wet-to-dry gauze daily, and calcium alginate, or hydrofiber dressing 3 x a week.  The patients had various co-morbidities that affected the wound healing process. 

Current Clinical Approach

Our home health care company has a corporate team of certified wound and ostomy nurses (CWON) available for consultations. Following a request for wound consultation by the visiting clinician, the CWON identified each of these cases as non-healing chronic wounds secondary to epibole. A recommendation was made to apply a polymeric membrane dressing (PMD) using the same technique that was presented in a previous poster presentation at the WOCN 40^thannual conference. This technique uses rolled up gauze pressed firmly onto the PMD dressing to ensure firm secure contact across the wound bed and to the thickened rolled edges. PMDs were changed 3x a week.

Patient Outcomes

Using the appropriate application technique wound edges flattened and began to epithelialize and close.  Two of the three patients are currently discharged from home health with healed wounds.   

Conclusions 

Polymeric membrane dressings for management of epibole are an effective treatment when the appropriate dressing technique is employed.