Case StudiesCase series evaluation: the use of Durafiber on exuding wounds

Case series evaluation: the use of Durafiber on exuding wounds

Exudate Management, Leg Ulcers, Pressure Ulcers, Research, Skin integrity

Case 1: Treating foot ulcers with Durafiber (Simon Barrett)

Background
This patient was a man in his early 80s with a history of venous ulceration who was seen at the primary care wound clinic on 20 April, 2012.

Clinic visit 1
On examination, he was found to have two wounds on the right foot, one on the heel and one on the lateral right dorsum. Both wounds measured approximately 5cm x 5cm and were less than 1cm deep. The wounds were potentially caused by ill-fitting footwear and had been present for six months.

Previous dressings used on the wound included Aquacel® (ConvaTec) and Duoderm® (ConvaTec). The patient was also undergoing three-layer reduced compression and had emollients applied to the skin, although he was not taking any medication.


Presentation and treatment plan
The wound bed of ulcer one (right heel) demonstrated 80% granulation and 20% slough with an absence of epithelialisation. There was no necrotic tissue. Ulcer two (lateral right dorsum) demonstrated 50% granulation and 50% slough and also had an absence of epithelialisation or necrosis.

There was moderate serous exudate present in both wounds and the surrounding skin was macerated.

It was decided to use Durafiber to manage the exudate and reduce maceration in both wounds. The patient was also advised to stop wearing the ill-fitting footwear, which was thought to have contributed to the skin breakdown initially.

The clinician decided to use the 5cm x 5cm Durafiber on both wounds - a non-adhesive, shaped foam dressing (10cm x 10cm) was used as a secondary dressing. The next dressing change was planned for 27 April 2012.

Clinic visit 2
At the next clinic visit on 27 April, 2012, the Durafiber dressing proved easy both to apply and remove and was found to conform well to the wound bed. The dressing also demonstrated excellent fluid-handling properties and was effective at managing the wound exudate. The dressing remained intact on removal.

The condition of the skin surrounding the wounds at this change was healthy and the exudate level was moderate. The patient had no pain when the dressing was in situ.
Both wounds had improved, with ulcer one having decreased to 4.8cm in length and 4.5cm in width. Ulcer two had decreased to 4.6cm in length and 4.6cm in width. There was also 5% epithelialisation in each wound.

The clinician noted that the size reductions were due in part to less maceration.
The clinician decided to continue with the Durafiber with the same secondary dressing. It was also decided to continue with reduced compression due to the oedema in the patient's lower limb.

Clinic visit 3
The patient was seen again by the reporting clinician on 11 May, 2012. The dressing had been briefly changed by a different clinician to another gelling fibre product, which had resulted in some maceration to the periwound skin.

However, when the clinician reapplied the Durafiber, there was an immediate improvement in this maceration.

On application of the Durafiber at this visit, there was no pain and the ease of application remained very good. The dressings continued to demonstrate very good ability to conform to the wound beds. Exudate management remained excellent and the dressing proved comfortable for the patient.

Possibly due to the application of a different dressing the wound sizes had remained static and there was still only 5% epithelialisation.

The clinician decided to continue with Durafiber and compression.

Clinic visit 4
The patient was reviewed again on the 18 May, 2012 and the dressings were changed. At this change, the Durafiber was managing exudate well and the exudate was reducing in part due to the compression therapy. The periwound skin was now healthy and the exudate levels in both wounds had reduced to low. There was also no pain reported by the patient.

Overall, at this visit the wounds had improved and they continued to reduce in size. The clinician decided to continue with Durafiber due to its ability to cope with exudate and the lack of pain. Reduced compression was also continued.

Clinic visit 5
On the next review on 25 May, 2012, the patient was still following the appropriate dressing instructions. Ease of application was excellent, while conformability, exudate handling, patient comfort and ease of removal were all found to be
very good.

The periwound skin on both ulcers was healthy and there was also a reduced level of exudate in both ulcers. At this review the patient did not complain of any pain while the dressing was in situ.

Both wound beds now consisted of 90% epithelialising tissue and 10% granulating tissue and the wound was almost healed.

The plan was to continue with Durafiber through to complete healing.
The clinician noted that although there had not been a direct comparison in clinical practice, the Durafiber was performing better than the usual dressing used for this type of wound.

Discussion
After the final evaluation, the clinician recorded the following benefits to using the Durafiber dressing:

  • There was a considerable improvement in the condition of the periwound skin
  • Both wounds were almost healed in the treatment period
  • The maceration at initial presentation had resolved
  • The dressing was easy to remove and apply and there was no fibre shedding
  • The patient was very pleased with the outcome
  • The wound bed had improved at each clinical review.

The overall performance of Durafiber in terms of application, conformability and exudate management was found to be very good.