Problem: Many chronic ulcers are covered with non-viable tissue, are painful and challenging to treat. Often, these wounds need continuous debridement. For the past 10 years we’ve treated these types of ulcers with polymeric membrane dressings (PMDs).
Methods: We treated 252 patients with painful necrotic/sloughy wounds using enhanced autolytic debridement through use of PMDs. Chronic wounds included: 26 arterial wounds, 35 venous ulcers, 55 diabetic ulcers, 62 heel pressure ulcers and 74 other pressure ulcers. PMDs, with and without silver, were applied. 4 cases are presented: An 83 y.o. Palliative patient with a painful ankle wound with Type 1 Diabetes and Peripheral Arterial Disease. An 86 y.o. patient with a huge sacral pressure ulcer with Chronic Obstructive Airway Disease. A 96 y.o. Alzheimer’s patient with an extensive sacral pressure ulcer. A 92 y.o. Diabetic patient with a sacral ulcer infected with Methicillin-resistant Staphylococcus aureus (MRSA). Of the 252 cases, 25% were partially surgically debrided prior to use of PMDs. 9% were surgically debrided after PMDs, moistened with a few drops of sterile saline or water, were applied to the wound in order to soften the necrotic tissues.
Results: Complete, painless, enhanced autolytic debridement took between 3 to 10 days depending on type and size of the wound. The approach resulted in a smaller wound to be closed than would have been created by aggressive surgical debridement.
Conclusions: The reason for primarily choosing enhanced autolytic debridement was that surgical intervention was too stressful for patients with low albumin, hemoglobin and iron levels. Enhanced autolytic debridement is a significant advantage over other methods of autolytic debridement in that it’s painless and simultaneously promotes the healing process by instigating angiogenesis. PMDs helped us to provide continuous debridement, exudate control, prevention of wound trauma, prevention of infection and pain control.
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