JSTA December 2010 - Australian Association of Stomal Therapy ...

Figure 4. Ceased VAC ® treatment.
The surgeons formed an end colostomy in the left upper
quadrant of the abdomen to assist with patient self-care and
reduce continued perianal skin breakdown from incontinence
and pressure injury formation. This patient was not expected to
survive this pressure injury and did have a septic shower early
on in his admission.
Multidisciplinary teams have enabled this patient to make
significant progress; however, continued social support and
community support will be needed to reduce further pressure
injury formation.
Multidisciplinary team involved in patient care included:
• Dietician for nutritional support.
• Medical.
• Wound care.
• Nursing.
• Social worker (patient severe depression).
• Mental health.
• Community health.
• Domiciliary.
• Family and friends who were fundamental to patient finding
will to heal.
The main factor in his progress was the ability to treat using NPT
which could not happen without the use of the Adapt seals to
maintain a seal and protect his fragile skin. Thus Hollister Adapt
Barrier Seals resulted in a cost-effective sustainable solution
enabling wound improvement and better quality of life.
8 Journal of Stomal therapy australia – Volume 30 Number 4
cASe STudy 2:
Patient History
57 year old male, insulin dependant diabetic with advanced
neuropathy and osteomyelitis of Ist Metatarsal/phalangeal
joint (MTPJ).The patient had stood on a nail, not realised due
to neuropathy and the foreign body was in the foot for three
days. He was admitted with a septic left leg and cellulitis. At the
penetration site necrotic tissue extended 10mm x 10 mm on the
planter aspect of the foot. Tracking from puncture site extended
to the medial aspect of foot.
Management:
• Debridement of Left foot - 50 mm x 30 mm demarcated
necrosis with copious infected tissue down to facia, tracking
proximally to sole of foot
• A week later returned to theatre for a wash out. Necrotic
tissue to flexor tendon 2nd toe. At this stage Negative
Pressure therapy was applied.
• Four days later returned to theatre for a further washout.
• Two days later had an amputation 2nd toe
Medications:
Novorapid, Diabex, Augmentin Duo Forte
Issues:
• Continued leaking of Negative Pressure Therapy Dressing
reported by patient and staff due to difficulty and complexity
of wound position.
• Patient requiring frequent dressing application or
reinforcement of dressing.
• Heavy maceration to peri wound from exudate not able to be
contained
• Peri wound skin irritation from layers of film dressings to
maintain seal of negative pressure therapy dressing resulting
in stripping of skin (Patient mummified with drape).
• Patient discomfort from requirement of dressing to
encapsulate entire foot resulting in decreasing ability to
maintain hygiene and increase perspiration to foot.
• Need for monitoring and returning to clinics for management
of dressing daily
• Increased cost of dressing and nursing hours
Solution
Use of Hollister Adapt Barrier Seal (7805) to peri wound skin
• Enhanced ability of dressing to maintain a seal
• Conformability to odd shape and position of wound
• Seal ability to cope with heavy exudate levels and moisture
without increasing risk of maceration to peri wound skin.
• Ease of application for all staff