Management of Lower Extremity Hematomas Cause By Trauma in a Skilled Nursing Facility with a SUPER Absorbent Polymer Dressing (SAPD) with or without a Silver Oxysalt Contact Layer

Problem:  Skilled nursing facilities regularly manage their Resident’s traumatic wounds as a result of falls, bumping into objects, and other minor accidents.  Advanced age, co-morbidities, anti-coagulant therapy, and other medications, as well a residential living environment makes this population at risk for delayed healing and infection.

Goals of care:  Acute wounds tend to drain due to the inflammatory phase of wound healing.  The congealed blood and non-viable tissue requires conservative sharp debridement, continuing inflammation and higher exudate levels.   Our goals of care consist of prevention of infection, debridement of non-viable tissue, management of exudate, provision of a moist wound healing environment, manage pain, minimize dressing change frequency, and to minimize the risk of recurrent injury.

Previous Treatments:   The core of wound product selection is based on the assessment of the wound depth and exudate, goals of care, and function of the dressing.  Prior cases with a similar presentation would be managed with honey hydrogels, silver and non-silver alginates, and silicone foam dressings with varying degrees of success.

Proposed Solution:  Manage hematoma with ulceration by conservative sharp debridement, a primary silver oxysalt contact layer dressing if signs and symptoms of infection were present, covered by a non-adhesive SAPD, and secured with a gauze roll.  Dressing changes were completed weekly or as needed due to slippage, strike through, or clinical preference.

Results:  Two patients were managed with the proposed solution.  Expected outcomes were achieved within 2-3 weeks with weekly or bi-weekly dressing changes.  One case showed significant epithelialization in one week.

Conclusion:  The combination of dressings along with conservative sharp debridement proved effective in managing hematoma ulcerations and achieved expected outcomes.