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Case Study
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Maintaining tunnel tissue viability with silver polymeric membrane dressings during osteomyelitis treatment Linda Benskin, BSN Clinical: A 35-year-old man in Ghana, West Africa with a non-healing wound due to osteomyelitis secondary to an unset compound fracture incurred 10 months prior to treatment. Left hospital AMA to avoid amputation. Surface wound self-treated with amoxicillin powder and petrolatum mixture. Proximal right ankle wound 2cm long x 3cm wide with adjacent 2.5cm deep tunnel extending to the bone. Weight-bearing on deformed leg was painful. Relative humidity during treatment was often below 10% and always below 30%, which can interfere with maintaining a moist wound-healing environment. Tunnel needed to be kept open until dead bone particles were ejected. .Rationale: Silver polymeric membrane dressings and wound filler have both demonstrated the ability to provide the antimicrobial benefits of silver in low humidity environments because of residual moisture in the dressing and the natural hydrophilic action of the dressing. Antimicrobial filler provided a mechanical means to keep the tunnel, which served as a portal of exit for dead bone, open, infection-free and appropriately moist until osteomyelitis resolved. Method: Treatment included nutritional counseling, prayer and oral antibiotics in addition to direct wound care. Silver polymeric membrane wound filler was inserted into the tunneling wound and a film-backed polymeric membrane dressing, with or without silver, was placed over the entire wound area. Infection was controlled quickly and dead bone fragments were removed from the base of the tunnel as they were expelled by the body. .Conclusion: Tissue along the inner edges of the tunnel remained viable. Patient was able to continue farming during treatment. Walking became pain-free when osteomyelitis resolved. Wound completely healed in seventeen weeks and did not recur. Standard and silver polymeric membrane dressings provided excellent results during entire healing process even in conditions of extremely low humidity. Silver polymeric wound filler kept the tunnel wound tissue viable until closure. Cutting KF, White RJ. Criteria for identifying wound infection: revisited. Ostomy Wound Manage. 2005;51(1):28Ð34 Driver VR. Silver dressings in clinical practice. Ostomy Wound Manage. 2004;50(suppl 9A):11SÐ15S Hess CT. Wound care clinical guide. Ambler, PA: Lippincott Williams & Wilkins, 2005 Lansdown ABG. Silver I: Its antimicrobial properties and action. J Wound Care. 2002;11(4):125Ð130 Ovington LG. The truth about silver. Ostomy Wound Manage. 2004;50(suppl 9A):1SÐ10S Rolstad BS, Ovington LG, Harris A. Principles of wound management. In: RA Bryant (ed). Acute and Chronic Wounds Nursing Management, Second Edition. St. Louis, MO: Mosby, 2000 Rolstad BS, Ovington LG, Harris A. Wound care product formulary. In: RA Bryant (ed). Acute and Chronic Wounds Nursing Management, Second Edition. St. Louis, MO: Mosby, 2000 Coppi C. I dressed your wounds, God healed you: a wounded personÕs psychology according to Ambroise Pare. Ostomy Wound Manage. 2005;51(8):62Ð66 . |
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