Abstract: Healing Wegener's Granulomatosis Necrotic Ulcers Utilizing Selective Debridement Methods (49th Annual Conference (May 19-23, 2017))

Adeline Galvez, BSN RN CWON, Wound and Ostomy Nursing, Texas Health Harris Methodist Fort Worth, Fort Worth, TX and Lisa Stewart, BSN RN CWOCN, Wound and Osotmy Nursing, Texas Health Harris Methodist Fort Worth, Fort Worth, TX

Healing Wegener’s Granulomatosis Necrotic Ulcers Utilizing Selective Debridement Methods

Background:

Wegener’s Granulomatosis is a necrotizing small vessel vasculitis that can affect any organ in the body but mainly affects respiratory tracts, kidneys, joints, skin and eyes. (1) Nonetheless, cutaneous ulcers are uncommon initial manifestation.(2) Dermatologic manifestations maybe treated with topical steroids or surgery in cases of severe tissue damage due to necrosis. (3)

This retrospective case study demonstrates the use of Noncontact Low-Frequency Ultrasound (NLFU)* in combination with enzymatic debrider in a patient with necrotic ulceration to buttocks related to Wegener’s granulomatosis. Treatment effectiveness was evaluated using the absence of necrotic tissue, increased granulation and decrease in wound size. Treatment was continued until the wound bed was 100% granulated.

NLFU utilizes sound wave energy to mechanically stimulate cells. This results in reduction of bacteria, disruption of biofilm as well as improved blood flow due to vasodilation.(4)

Enzymatic debriders, degrade necrotic tissue without harming viable granulation tissue. Over the years, various enzymes have been used for debridement. Enzymatic debriders works by selectively cleaving the collagen bonds that hold necrotic tissue to the wound bed. (5)

Case Presentation:

The patient is a 48 year old male admitted for multiple painful rectal ulcerations. Comorbidities include, diabetes mellitus type 2. Upon arrival, wound bed was covered with necrotic tissue.

NLFU treatments were administered daily for 5 days, in conjunction with enzymatic debridement x 3 days. After 5 days , NLFU was administered 3 times per week until patient was discharged.

After day 3, necrotic tissue was absent in wound bed. Wound related pain was resolved.

Discussion:

This case study demonstrated that treatment of Wegener’s necrotic ulcerations with the combination of NLFU and enzymatic debridement resulted in successful removal of necrotic tissue and granulation of the wound bed. An additional benefit was avoidance of the need for surgical debridement.