EWMA 2013 - Ep564 - DEVELOPING A TIME CONCEPT TREATMENT IN A POST-TRAUMATIC WOUND WITH HEMATOMA IN THE LOWER EXTREMITY

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L. BALTÀ DOMÍNGUEZ, M. BERENGUER PÉREZ, F-J. CORPAS ALCALÁ and C. SANTIAGO FERNÁNDEZ(1)
P. WILKEN(2)

(1) SAP Muntanya. Institut Català de la Salut, Barcelona, Spain
(2) URGO GmbH, Sulzbach, Germany

Published in: Health & Medicine, Business
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EWMA 2013 - Ep564 - DEVELOPING A TIME CONCEPT TREATMENT IN A POST-TRAUMATIC WOUND WITH HEMATOMA IN THE LOWER EXTREMITY

  1. 1. DEVELOPING A TIME CONCEPT TREATMENT IN A POST-TRAUMATIC WOUND WITH HEMATOMA IN THE LOWER EXTREMITY L. BALTÀ DOMÍNGUEZ, M. BERENGUER PÉREZ, F-J. CORPAS ALCALÁ and C. SANTIAGO FERNÁNDEZ(1) P. WILKEN(2) (1) SAP Muntanya. Institut Català de la Salut, Barcelona, Spain (2) URGO GmbH, Sulzbach, Germany
  2. 2. INTRODUCTION In patients with venous disease, one element that causes wounds is the occurrence of accidental traumas. The overall evaluation of the person with a wound has been found to be fundamental for their treatment and recovery, and its objective is to detect those aspects which might have a negative impact on wound healing. The TIME concept is a strategy recommended for health professionals that helps us to assess chronic wounds during each wound care procedure, enabling us to detect problems and determine the actions to be taken to achieve better, faster healing.
  3. 3. OBJECTIVES To deslough non-viable tissue (TIME), control inflammation/infection (TIME), ensure optimum management of exudates (TIME) and stimulate epithelial margins (TIME), the aim being to obtain the complete epithelialisation of the wound.
  4. 4. METHODOLOGY Two clinical cases are described, dealt with in Primary Care treatment consultations for traumatic wounds in which haematoma/significant soft pressure ulcer was present during the initial assessment.
  5. 5. 78 year-old female patient with a history of: arterial hypertension, type-2 diabetes mellitus, dyslipidaemia, arthritis, osteoporosis and glaucoma. On 18.04.2012 she suffered an accidental fall, presenting trauma in the pretibial area of the right leg. At fifteen days the patient had developed pain, redness, local heat and drainage of serious exudate via the right lateral area of the wound where she presented a small open wound. Presence of haematoma and soft pressure ulcer which moves on palpation and is not resorbed under compression therapy. It was decided to carry out surgical desloughing to remove all the necrotic tissue. After desloughing the patient presented an open wound 8 cm in length x 8 cm in width x 2.5 cm deep, with abundant sero-haematic exudates, residues of necrotic tissue (30%) and slough (35%). CLINICAL CASE 1
  6. 6. 17.05.2012 CLINICAL CASE 1 13.07.2012 10.08.2012 14.09.2012 16.10.2012
  7. 7. 70 year-old female patient, with a history of: arterial hypertension, type-2 diabetes mellitus and arthritis. On 15.05.2012 she suffered a spontaneous fall on the public highway, and was admitted to the Care Centre after fifteen days, presenting soft slough. It was decided to carry out surgical desloughing, and after the necrotic tissue was removed the patient presented a wound 10 cm long, 8 cm wide and 3 cm deep. The patient presented 70% sloughy tissue and 30% granulation tissue. CLINICAL CASE 2
  8. 8. 07.05.2012 14.05.2012 11.06.2012 02.07.2012 30.07.2012 CLINICAL CASE 2
  9. 9. CLINICAL CASES In both cases, after surgical desloughing, desloughing with polyacrylate hydro-desloughing fibre and TLC dressing* was initiated due to the high content of slough covering the wound bed, protecting the skin around the wound with a non-irritating barrier film and applying short-stretch compression bandages. Once desloughing had been carried out, treatment with a polyurethane foam type dressing was continued with TLC-NOSF dressing*. In view of the persistent high quantity of sero-purulent exudate a surface culture was carried out and the following result was obtained: Pseudomonas aeruginosa (in the first case) and Escherichia coli (in the second case). In both wounds a dressing was applied consisting of pure activated charcoal impregnated with silver, wrapped in a double mesh of nonwoven nylon fibres, enabling the infection to be effectively controlled, with optimum exudate management. The rest of the treatment was maintained: protection of the skin surround the wound and short-stretch compression bandages, with protection of bone prominences. *Brand names: the TLC dressing* is UrgoClean® and the TLC-NOSF dressing* is UrgoStart®
  10. 10. RESULTS The course of both clinical cases presented confirms that the presence of haematoma / soft pressure ulcer (slough) requires desloughing in order to obtain total epithelialisation of both wounds after 2 months of treatment. The evaluation of the dressing applied, in terms of reducing the bacterial load, exudate management (favouring drainage), odour reduction, convenience of application, enabling removal in one piece and easy adaptability and an improvement in the quality of life of the patient.
  11. 11. The wounds treated applying the TIME concept enable us to treat the wound bed and stimulate the scarring process by reducing the oedema, the exudates and the bacterial load. Moreover, the use of the TIME concept reduces the economic cost of the treatment of wounds by making rational and effective use of the dressings and material required for each healing procedure. CONCLUSION *Brand names: the TLC dressing* is UrgoClean® and the TLC-NOSF dressing* is UrgoStart®

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