Scientific and Clinical Abstracts From the 41st Annual Wound, Ostomy and Continence Nurses Annual Conference, St. Louis, Missouri June 6–10, 2009: Practice Innovation Abstract
TOPIC: Achieving clean moist wound beds in tunneling wounds.
PURPOSE: A confused, bedbound 89-yr-old male arrived with a stage IV right trochanter pressure ulcer with deep tunneling at 12 and 3 o'clock. The wound was dressed with enzymes, alginate and/or silver hydrofiber, but despite repeated attempts, the openings of the long, narrow tunnels were too small to thread more than a small corner of thin alginate or ¼ wide iodoform strips into them. After 5 months, wound was 3.5 cm × 3.0 cm × 1.0 cm deep with 30% granulation tissue, 10% epithelized and 60% pale red tissue with slightly rolled edges; tunnels remained 3.5 cm and 5.0 cm long.
OBJECTIVE: The tunnels remaining their original size as the wound closed raised the concern of creating a nonhealing abscess. A method of balancing the moisture in the tunnels and stimulating healing without damaging the cavity wound bed was needed.
METHODS: The Wound Ostomy Continence Nurse suggested trying the new silver rope dressing designed specifically for tunneling wounds. The rope was easily inserted into each tunnel and cut to length so the ends filled the open wound bed. The filled area was covered with a bordered foam dressing to provide the optimal moisture vapor transmission rate. Removing the saturated dressings was atraumatic and easy because they are nonadherent and do not break apart.
OUTCOMES: At one week, the wound bed was 90% granulation tissue and 10% epithelized and with 100% open margins. Maximum tunnel length had decreased from 5.0 cm to 4.0 cm. The tunnels filled in quickly; then the cavity wound steadily healed. The wound was completely closed after only 10 weeks of treatment using the new silver rope.
CONCLUSION: The silver rope dressing is very easy to insert into long narrow tunnels and tracts. This patient healed very quickly, matching our experience with standard silver dressings of the same family.