Case Study 3:
The ITI Wound Treatment System successfully healed a complex wound at risk for amputation
Description
A 48-year-old Caucasian male was presented to a long-term acute care (LTAC) hospital with gunshot wounds to the dorsal and plantar aspects of his left foot. The wounds to both aspects were connected by an open lumen approximately 1 cm in diameter. The first metatarsal, directly in the path of the bullet, was destroyed. The second and third metatarsals were completely shattered by the bullet.
Nine to 10 years prior to this event, the patient had successfully undergone chemotherapy treatment for non-Hodgkin's lymphoma. The patient was in remission. In addition, at various times he had been treated with oral medications for hypertension, hyperlipidemia, and hypothyroidism.
The patient had undergone orthopedic surgery to stabilize the bones on the foot. Hardware and external fixation pins were placed adjacent to the dorsal wound to hold in place the bone, which was missing a 1.5 cm segment. Jagged bone edges continued to be exposed post-surgically. Some foreign matter remained unextracted in order to avoid further damage to the foot structure.
Post-surgically, the patient was at high risk for infection and amputation. He required acute post-operative care. The patient was prescribed 14 days of IV antibiotics. Saline-moistened gauze dressings were initiated. Calcium alginate was applied around the pin sites to promote healing and manage drainage. Although negative pressure wound therapy (NPWT) was clearly indicated for this patient, medical staff expressed concern that the surgically implanted hardware would prevent a reliable vacuum seal.
Results
Upon admission to the LTAC hospital on 12/4/09, patient notes indicated that after surgery he experienced extreme pain during dressing changes and was markedly anxious about future dressing changes. The wound beds were red and non-granulating - with moderate to large amounts of serosanguinous drainage. The LTAC hospital team prescribed the ITI Wound Treatment System.
Conclusion
The ITI Wound Treatment System was effective in promoting the formation of granulation tissue, resolving inflammation and edema of the wound bed, and managing wound drainage. The foam dressings' flexibility and strength accommodated the challenges of surgically implanted hardware. Negative pressure wound therapy with the ITI Wound Treatment System salvaged a seriously damaged foot, avoiding possible amputation.
Case submitted by: B. Haney RN WCC, Select Specialty Hospital, Topeka, KS.