An integrative approach to a chronic wound: Using a collagenase enzyamatic debrider with hydrotherapy lavage

This is single case study of a 54 year old diabetic male admitted to the hospital with initial diagnosis of Chronic Kidney Failure,  Heart Failure and Uncontrolled diabetes. Patient also had a chronic non healing diabetic foot ulcer for over 6 years. Vascular surgeon consulted wound care nurse for topical wound care treatment. Recent MRI did not show osteomylitis so surgery was ruled out. However, it was also determined that patient would need dialysis after discharge from the hospital. Discharge planning was involved in arranging this with an outpatient dialysis clinic. The scheduled visits three times weekly to get dialysis would likely interfere with home health visits for wound care.

It was therefore imperative to try to rid the wound of the biofilm, odor, and adherent slough. The goal of the wound care nurse was to have the wound bed prepared prior to discharge from the hospital. Wound care treatment plan involved a collagenase enzymatic debrider applied to wound bed twice daily, along with daily hydrotherapy lavage used at the bedside.

There was a remarkable dramatic improvement in the wound bed within 3 days. There was <5% slough, no odor, and pink wound bed. Patient was discharged home with wound care orders for bid wound gel with damp normal saline gauze. Patient was instructed on wound care prior to discharge and would be able to change dressing on the days home health was unable to see him.