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 4: Treating a sacral pressure ulcer with Durafiber (Jackie Stephen-Haynes; Rosie Callaghan)

Background
The patient was a female in her mid 80s who was being cared for in a nursing home. She had a history of cerebrovascular accident, hypertension and dysphagia. She was immobile and had a urinary catheter and a percutaneous endoscopic gastrostomy (PEG) tube in situ. She had developed a grade three sacral pressure ulcer five months earlier when her mobility had reduced and she had been sitting for long periods of time without adequate pressure relief. She was now being repositioned using a hoist and a turning regimen was in place.

Presentation and treatment plan
The cavity wound was on the sacrum and measured 3.5cm x 5cm and was 2cm deep. The wound exhibited 100% granulation tissue. There were heavy levels of serosanguinous exudate. The surrounding skin was macerated and there was undermining at the edges, up to 1cm at the wound's proximal margin. Negative pressure wound therapy had been considered but the patient was known to become agitated easily and may have found the associated equipment difficult to tolerate. Durafiber (2cm x 45cm) was chosen as a treatment option because of the heavy levels of exudate. AllevynTM Gentle Border (Smith & Nephew) was used as a secondary dressing.

Week 1
The wound was assessed after one week. The clinician found that the dressing was excellent for ease of application and removal. In addition, patient comfort was found to be excellent. The dressing provided good conformability to the wound bed, remaining intact on removal.

The exudate was still heavy at this point and the surrounding skin remained macerated and inflamed. The pain levels remained the same (the patient was receiving regular analgesia related to spasms linked to her cerebrovascular accident, but experienced no pain from the dressing changes).

The wound dimensions had not altered, but the undermining had reduced and was barely measureable and the wound was healing at the edges. The wound bed exhibited 100% granulation. It was decided to continue with the treatment regimen but switch to AllevynTM Gentle Border Multisite (Smith & Nephew) as a secondary dressing.

Allevyn Gentle Border Multisite was chosen as the secondary dressing as it was easy to apply and the specific shape of the dressing would aid dressing retention. Patient comfort was described as very good and the Durafiber dressing was easy to remove and remained intact.

Week 2
After two weeks of treatment the wound exhibited very heavy exudate. There were signs of infection (thought to be caused by incontinence) and the surrounding skin was inflamed. It was decided to introduce a silver dressing in order to address this, however, Durafiber was used again after five days. The dressing was being changed every 2-3 days depending on the exudate levels.

Week 3
After three weeks of treatment (including five days using the silver dressing) the wound had reduced in size to 3cm x 4cm and 0.5cm deep, with no undermining areas. There were still heavy levels of exudate and the wound bed exhibited 90% granulation tissue and 10% epithelialisation - the surrounding skin was now described as healthy with reduced maceration.

It was decided to continue with Durafiber and a switch was made to a different size -10cm flat sheet.

Week 4
The Durafiber dressing had been in place for three days. The dressing was said to be as good as the one that was usually used for this clinical indication at the care home. Exudate levels had reduced and were now described as moderate.

The wound had again improved and now measured 3cm x 3cm with a 0.5cm depth. The wound bed exhibited 10% epithelialisation at the wound margins and 90% granulation. There were still concerns about infection as the wound was very near the peri-anal area. It was decided to continue treatment with Durafiber (now using the 5cm x 5cm size cut into a spiral so that it could be packed into the shallow wound).

Discussion
The cavity wound had greatly improved since the beginning of the treatment. The temporary step up to a silver dressing had helped with the infection caused by incontinence and the wound had gradually improved over the treatment trial. The dressing was easy to use and comfortable for the patient. It was felt to be as good as the standard dressing that would have usually been used for this complex wound by the care home staff.