How a Dressing Completely Changed the Life of a Palliative Care Patient

Problem: An otherwise healthy 55-year-old man (pseudonym “Ray”) underwent palliative flap-graft surgery post terminal sacral sarcoma removal and was left with two (3x2.3x1.4cm, and 1.1x0.8x0.5cm with circumferential 0.5cm undermining and exposed bone) non-healing left trochanter wounds. Ray’s family dressed his wounds, guided by wound clinic physicians and home health. Despite chemotherapy, Ray struggled to maintain his modest masonry business.

Past Management: Nine months of no improvement with negative pressure wound therapy (NPWT) on the larger, heavily exudating, cavity wound and silver hydrofiber on the wound with the exposed bone led to frustration and weariness.

New Clinical Approach: Wound management was changed to adhesive-bordered polymeric membrane dressings (PMDs) with silver PMD wound filler for the wider cavity wound and silver PMD rope for the narrower wound. Dressing changes were easier, quicker, and pain-free: the saturated PMDs were simply removed and replaced without rinsing. These continuously cleansing dressings allayed fears of infection and set Ray free of “the machine.” 

Patient Outcomes: Without NPWT, Ray was able to sleep well for the first time in nine months. Inflammation subsided. At jobsites, Ray could safely ignore his wounds. Surprisingly, despite chemotherapy, both wounds granulated quickly, closing completely within seven months.

Ray enjoyed ~eight wound-free months before the tumor recurred, growing rapidly. The flexibility, cuttability, and elasticity of PMDs proved especially helpful in dressing the inoperable rapidly growing (maximum ~20x20x10cm) protrusion to prevent infection. Nonadherent PMDs so completely controlled the bleeding and odor usually accompanying large fungating wounds that visitors were not distracted by Ray’s large tumor, even in his final days.

Conclusions: Ray benefited from the many unique attributes of PMDs working together in his three very different wound types: a heavily exudating wound, a narrow wound with exposed bone, and a large fungating tumor, dramatically improving the final sixteen months of Ray’s life.