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Necrotic PU Case Study: Vernon, T

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IntraSite Conformable in the treatment of necrotic pressure ulcers.

 

Introduction
The presence of necrotic devitalised tissue on a wound bed can delay healing and also increase the risk of wound infection. Hydrogels effectively rehydrate devitalised tissue as the dressing facilitates the autolytic process allowing the separation of viable from non-viable tissue. Difficulties can be found when dressing awkward areas, as care must be taken to maximise the contact of the hydrogel with the wound.

 

The Patient
Gladys is an 85 year old lady who was admitted to a acute medical ward having had a history of falls at home. She presented with a large necrotic pressure ulcer to her right heal (see figure 1).

 

The Challenge
To manage a necrotic pressure ulcer in an awkward area.

 

Interventions
IntraSite Conformable was opened out and placed over the area of the necrosis as per the manufacturer's instructions (see Figure 2), and then covered with Allevyn* Heel dressing (see Figure 3). This ensures that maximum contact is made with IntraSite Conformable and the wound. The dressing regime was carried out every three days. After 10 days the necrotic tissue had been rehydrated to allow sharp debridement to take place (see Figure 4). This procedure was carried out by the Clinical Nurse Specialist - Tissue Viability who has extensive expertise in this area (see Figure 5).

 

IntraSite Conformable continued to be used as previously described allowing debridement to be carried out at the weekly visuit by the Clinical Nurse Specialist - Tissue Viability (see Figure 6).

 

Fig 1

Fig 2

Fig 3

 

Aims

  • To use a dressing which would rehydrate hard necrotic tissue.
  • To use a dressing which would stay in contact with the wound.
  • To provide the optimum environment for wound healing.
  • To ensure maximum contact between the dressing and the wound interface.
  • To select a dressing which would enhance the properties of the primary dressing.

 

Outcome
Sharp debridement is often viewed as being the quickest and most effective method of removing necrotic tissue. Initially this is not always an option when dealing with elderly, frail patients. IntraSite Comformable has proved to be effective in rehydrating necrosis allowing debridement to be carried out on a weekly basis.This has undoubtedly proved to be a positive outcome (see figure 7).

 

Fig 4

 

Fig 5

 

Fig 6

 

Fig 7