Resolving Epibole with Polymeric Membrane Dressings* in Home Care

Abstract

Clinical Problem: During wound healing, full thickness wounds may become chronic due to closed or rolled non-proliferative wound edges. This condition is known as epibole. Generally, epibole is treated via surgical excision or chemical cauterization. For the homebound patient, these treatments are not always a viable option due to limitations of: accessibility, tolerance, affordability, comorbidities, and function. Patients’ past treatments ranged from daily wet-to-dry gauze dressing changes to calcium alginate, and hydrofiber dressing 3 x a week. The patients had various co-morbidities that affected the wound healing process. 3 case studies will be presented: a 62 y.o. female with dehisced surgical wound, 58 y.o. female with pressure ulceration, and a 53 y.o. female with surgical wound.

Current Clinical Approach: Our home health care company has a corporate team of certified wound and ostomy nurses (CWON) available for consults. Following a request for wound consultation by the visiting clinician, the CWON identified each of these cases as non-healing chronic wounds secondary to epibole. A recommendation was made to apply a polymeric membrane dressing (PMD) using the same technique that was presented in a previous poster presentation at the WOCN 40th annual conference. This technique uses a rolled up gauze pressed firmly onto the PMD dressing to ensure firm secure contact across the wound bed and to the thickened rolled edges. PMDs were changed 3x a week. Per physician orders the wounds were cleansed during dressing changes and a skin barrier was applied on the periwound skin.

Patient Outcomes: Using the appropriate application technique, wound edges flattened and began to epithelialize and close. 2 of the 3 patients are currently discharged from home health with healed wounds.

Conclusions: Polymeric membrane dressings for management of epibole are an effective treatment when the appropriate dressing technique is employed.

References
Baranoski S, Ayello EA. Wound care essentials: Practice Priniciples. 3rd ed. Ambler, PA: Lippincott Williams & Wilkins;2012.
Benskin L. Solving the Closed Rolled Edge Problem in Venous Ulcers and Other Chronic Wounds Using Standard or Extra-Thick Polymeric Membrane Dressings* 40th Annual WOCN Conference. June 21-25, 2008. Orlando, Florida.
Grey J, Enoch S, Harding KG. ABC of wound healing. Wound assessment. BMJ. Feb.2006; 232:285-288.Thomas Hess C. Clinical guide to skin & wound care. 7th ed. Ambler, PA: Lippincott Williams & Wilkins; 2013.

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