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STATEMENT OF THE PROBLEM: This 94 year old woman had endured treatment for chronic venous hypertension (idiopathic) with ulcer and inflammation of left lower extremity for over two years in a community based wound clinic using petroleum based product and light compression without progress towards healing.
She was referred to home care services and presented with edema of her left leg, dry, fragile skin, multiple open areas extending from knee to foot circumferentially. The leg was reported to have no infection/deterioration and was deemed to be a chronic stable situation.
The home care WOC nurse did her evaluation and discovered the wound care itself took over two hours due to pain and the extensive nature of the wounds. She was essentially bedbound secondary to pain and diminished quality of life.
DESCRIPTION OF CLINICAL APPROACH: The holistic approach included wound care, biofilm considerations, nutrition, psychosocial/spiritual aspects and pain management. Upon evaluation, the DIMES approach was used for her treatment plan. It was suspected that biofilm caused the tissue to be very fragile and caused ongoing exacerbations of the ulcers and extreme pain. 1. To decrease pain caused from adherence of tissue at dressing changes and to reduce biofilm, an antimicrobial cleanser followed by the application of a concentrated surfactant based gel with micelle technology. 2. A silver foam was applied for antimicrobial effect and exudate absorption. Secondary dressings included a large non-adherent exudate absorber and two layer compression wrap to control edema. Following wound culture, two courses of antibiotics were administered. A high protein supplement was introduced to support her healing, family support provided and spiritual renewal encouraged.
RESULT: Within 169 days, the above clinical approach not only resolved her wounds, restored skin integrity, decreased pain and greatly improved the quality of her life.