Managing Complex Wounds using Air Fluidized Therapy in the Long Term Acute Care setting: A case series

Clinical Problem: Complex wound management is challenging even for the most experienced clinicians.  Long-Term Acute Care (LTAC) facilities admit patients who suffer from multiple medical conditions, may have catastrophic or acute illnesses and/or injuries. Common care goals in LTAC’s aim for a reduction in wound size or complexity, allowing the patient to move to the next step in the care process, and not always complete wound healing.

Past Management: Our facilities past management included low air loss alternating pressure mattresses and other wound care products to promote wound healing in patients with advanced wounds.

Current Clinical Approach: Along with a multidisciplinary approach we now use Air Fluidized Therapy (AFT) which provides a unique fluid environment that maximizes the envelopment of the patient and providing aggressive off-loading of the wounds.  As in the past, we combine this therapy with early adequate debridement, appropriate dressings, and biophysical therapies as deemed appropriate.

Patient outcomes: A series of 12 patients with 28 wounds were enrolled in a study to evaluate a new AFT bed.  On average patients were 63 years old, 50% male, weighed 177 pounds, had Braden of 12.3 and 75% had compromise of overall health status.  10 of 12 were incontinent, and 2 were managed by ostomies. 

Wounds treated included 2 large tissue defects associated with surgical excisions for treatment of gangrene and 26 pressure injuries.   On admission, wounds had an average of 45 cm², and the mean percentage healed was 57.4% over an average of 27 days of therapy.  Specific patient challenges and outcomes will be described.

Conclusions: Effective management of complex wounds in medically complex patients represents a significant clinical burden.  Diligent care is required to achieve positive outcomes and reduce the rate of wound-related complications.  Sharing this series of patients may allow discussion and learnings amongst the WOCN community.