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 2: Treating a mixed aetiology leg ulcer with Durafiber (Simon Barrett)

Background
The patient was a female in her early 80s who presented at the wound clinic on 25 May, 2012. She had a history of ischaemic heart disease, atrial fibrillation, arthritis and osteoporosis. She had no history of previous wounds. Her mobility was limited by her arthritis, but she was independent and living at home with the support of her daughter who was a nurse.

The wound of seven months' duration was located on her right lateral malleolus and measured 1.8cm long by 1.5cm in width. It was thought to be of mixed aetiology and the plan was to perform a Doppler ultrasound on 29 May to assess the presence of arterial disease. The wound was very sloughy (80% slough) with approximately 20% granulation tissue.

There were moderate levels of exudate and the surrounding skin was quite macerated. A Durafiber 5cm by 5cm dressing cut to size with a 1cm border was chosen. It was thought that the trauma may have initially occurred as a result of pressure due to awkward positioning when the patient was in bed and the plan was to provide a pressure-relieving mattress with supportive education and advice.

Week 1
The dressing was changed after four days. The clinician found the dressing performed well and was very easy to remove and stayed in one piece. It was also very good at conforming to the wound bed. The wound at week 1 remained much the same in appearance as at initial presentation with moderate exudate levels and lots of slough present (80%). The ABPI for the left ankle was 0.88 and 1.09 for the right. Although the ABPI was within normal limits, the patient had a history of pain being relieved by rest, and had also suffered from night cramps. In view of her increasing arterial problems and pain experience, the patient was advised to return to the GP for onward vascular referral.

Week 2
After two weeks of treatment, the wound had improved and reduced in size, measuring 1.6cm in length and 1.2cm in width. The dressing had proved effective at coping with exudate and had remained in situ for five days. Overall, the wound was healing and although still quite sloughy, the thickness of the slough seemed to be reducing and the surrounding skin was less macerated.

Week 3
After three weeks of treatment the wound had reduced further in size to 1.5cm in length and 1cm in width. There was 30% granulation tissue present and the slough had reduced to 70%. In view of this positive healing progress, the plan was for the patient to continue with Durafiber and to go on her previously booked holiday and have her dressings changed by her daughter (a nurse) with a review appointment booked for 25 June.

Week 4
The Durafiber dressing had been in place for four days and continued to perform well with excellent ease of application, ability to conform to the wound bed and ability to remain intact during removal. The wound measured 1.5cm in length and 1.2cm in width and although this had increased from the previous visit, the patient had been more active than usual while on holiday. The surrounding skin was no longer macerated and appeared healthy.

Discussion
This patient with a chronic mixed aetiology ulcer of long duration seemed to respond positively to the dressing regimen used. The clinician found that Durafiber performed well and was easy to apply and remove in one piece.

The patient's daughter was able to manage the dressing changes while the patient was on holiday. The wound reduced in size over the four-week period and the condition of the skin surrounding the wound had improved from the macerated state at initial presentation to being healthy by the end of the evaluation period.