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Improved Exudate Control Utilizing Advanced Moisture Management Dressings for Diabetic Foot Limb Salvage, Surgical and Post Operative Wounds

Improved Exudate Control Utilizing Advanced Moisture Management Dressings for Diabetic Foot Limb Salvage, Surgical and Post-Operative Wounds

Babajide A. Ogunlana DPM, FACFAS, PCWC -Chief of Podiatric Surgery at Memorial Hermann Southwest Hospital in Houston, Texas

BACKGROUND

Surgical wounds closed with sutures  or staples1 heal by primary intention.  Wounds generated from limb salvage  surgery often cannot be closed  simply by sutures and follow a  healing path like that of a chronic  wound. These surgical wounds can produce large amounts of drainage  which can lead to higher chance for  maceration, breakdown to the  surrounding skin, and even  dehiscence. The wound dressings  utilized need to not only manage the exudate but provide protection to  the surrounding skin while the wound  progresses through the healing  cascade.

 

METHOD

A case series study was conducted  consisting of a 15-patient sampling  that underwent potential lower limb-saving surgery, such as flaps, wound  closure, and digit/partial foot  amputation requiring drainage  control.

An advanced moisture management  dressing* was utilized as the primary  dressing for exudate control and  protection to the peri wound. The  technologywithin the dressing wicks  away excess exudate while  maintaining a moist wound  environment2.

Following sharp surgical debridement and wound bed preparation, the moisture management dressings  were applied to the wound and multi-layer compression** was used  when clinically necessary.

Dressing change frequency varied based on drainage levels from once a week (low) to upwards of three times per week (high). The wounds  were examined for exudate amount, quality of the wound bed/peri-wound, overall patient comfort, and  ease of use.

 

CONCLUSION

The advanced moisture management dressings were able to handle the varying drainage levels while still  maintaining an optimal environment at the wound and peri-wound skin.

Patients were adherent and overall  wound outcomes improved with this  course of treatment.

Exudate levels managed with this  moisture management dressing  coupled with standard and advanced  wound care treatment protocols,  including serial sharp wound  debridement and edema control,  showed promising results in advancing wound healing in these very complex limb salvage cases.

 

RESULTS -CASE EXAMPLE#1

  • 56 years old AAF with raging gas forming infection in a chronic non-healing diabetic foot ulcer. Was Initially recommended for Right BKA.
  • Emergently taken to OR for Right great toe amputation, partial first ray amputation with wide excisional debridement –Copious amounts of drainage.
  • Xenograft application on 07/27/2020 with non-adherent dressing and moisture management dressing* usage for exudate control.
  • Wound fully healed on 12/31/2021.

 

 

 

 

 

 

RESULTS -CASE EXAMPLE#2

  • 56 year old AAM with wet gangrene in both feet for >3 months. Underwent Right foot open TMA, Left foot open TMA of the “gangrene slippers”.
  • Right: Packed with packing strips, non-adherent gauze and moisture management dressing*. Left: non-adherent primary dressing and two (2) moisture management dressings*. 
  • Xenograft application on 02/19/2021 with non-adherent dressing and moisture management dressing* usage for exudate control.
  • Right: Wound progressed towards fully healed.  Left: Wound continues to contract and progress towards healing with continued moisture control from the dressings.

 

 

 

 

 

 

 

FOOTNOTES

Milliken Healthcare Products, LLC, Spartanburg, SC:

Active Fluid Management Technology

*TRITEC Silver, ULTRA Silver, ULTRA,  ULTRA Border,AGILE

**CoFlex TLC two-layer compression

 

REFERENCES

  1. Dumville JC, Gray TA, Walter CJ, etal. Dressings for the prevention of surgical site infection. Cochrane Database Syst Rev.2016;12(12):CD003091. Published 2016 Dec 20.doi:10.1002/14651858. CD003091.pub4
  2.  Okan et al. The role of moisture balance in wound healing. Adv. in Skin and Wound Care 2007, 20:39-53

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