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 3: Durafiber used to treat a toe pressure ulcer (Jackie Stephen-Haynes; Rosie Callaghan)

The patient was a female in her late 90s who was being cared for in a nursing home. She had a history of cerebrovascular accidents, arthritis, peripheral vascular disease and poor nutritional status. She was immobile and had developed a grade four pressure ulcer on her foot due to poor circulation and rubbing from her shoe.

The toe joint on the left foot was hot and red and turning black. The ulcer was on her big toe joint and measured 3cm x 2cm with an unmeasured depth and had been present for six weeks. It had been treated with Sorbsan (Aspen Medical) and was unsuitable for compression.

The wound bed exhibited 80% granulating tissue with the possibility of overgranulation, and 20% slough. The area was prone to damage and trauma and had been protected using a Parafricta® (Parafricta) boot. The surrounding skin was macerated and it was difficult to see the wound margins. The wound had moderate exudate levels and the exudate was described as serosanguinous. It was decided to try Durafiber (5cm x 5cm) to treat the wound in conjunction with an absorbent pad and a retention bandage.

Week 1
The dressing was changed every three days and proved easy to apply, even though it was necessary to trim the dressing (it was easy to trim and cut cleanly without the fibres fraying). Its ability to handle exudate and conform to the wound bed was very good and the patient was comfortable when wearing the dressing. The appearance of the wound had improved after a week of treatment. The wound bed was still 80% granulation and 20% sloughy. It was decided to continue with the treatment regimen.

Week 2
After two weeks of treatment the dressing was being changed every 3-4 days. The clinician had some difficulty applying the secondary dressing as it was time consuming because of the position of the wound. Durafiber was easier to apply and its ability to conform to the wound bed and handle exudate was still deemed very good. Patient comfort was good and the dressing stayed intact on removal. The surrounding skin was healthy and the exudate levels had reduced and were
now low.

The wound was improved although it still had the same dimensions. It now comprised 100% granulation tissue.

Week 3
The wound was described as looking 'much better' and it had become shallower. It now measured 2cm x 2cm. The surrounding skin was healthy. There was now a moderate level of exudate. There had been fewer problems with the secondary dressing. Durafiber continued to perform well and the clinician commented that 'it seems gentle and easy to use'.

Week 4
At week four the wound was reassessed by the TVN. The wound was greatly improved and measured 2cm x 2cm with 100% granulation in the wound bed. The surrounding skin was healthy and the exudate levels low.

Discussion
The tissue viability nurse was pleased with the dressing and the progress made with the treatment. At times there had been difficulties with application and removal but once staff had been shown how to cut the dressing to fit the awkward position
of the wound these teething problems were reconciled.
Staff were also told that they did not need to stick to a strict four-day change and that they should assess the need to change the dressing based on exudate strike-through levels. The staff liked the dressing and found that it was effective in managing the wound. The patient reported that the dressing was very comfortable and she had no pain, although she was taking co-dydramol.