Case Study: Trauma Thumb
The Avance® Solo Negative Pressure Wound Therapy System is indicated for patients who would benefit from wound management via the application of negative pressure, particularly as the device may promote wound healing through the removal of exudate and infectious material.
Photographs and case notes kindly supplied by: Sanna Kouhia, Vascular Surgeon; Tuula Eskelinen, Wound Care Nurse; Arja Korhonen, Wound Care Nurse, the surgery outpatient clinic / wound outpatient clinic, Kainuu Central Hospital, Kajaani, Finland
Wound history
A 64-year-old male, with no comorbidities or current medications, presented with a trauma wound on the left hand thumb, acquired after an accident caused by a circular saw. The wound included a bone revealing injury and the fingertip had been amputated.
Initially, 7 days before baseline, the wound and the surrounding skin were cleansed with Microdacyn® hydrogel to remove dried blood. The treatment dressing chosen was Mepilex® Transfer Ag, a self-adhesive, silver dressing with Safetac® Technology.
The following day, a trauma surgery for the fingertip shaping was performed and post-surgical dressings Mepitel®, Mesorb® and a stretch bandage were applied immediately after the surgery.
Antibiotic treatment Kefexin 500 mg x 3 was prescribed to prevent wound infection.
Treatment regime
When the patient came to the wound clinic for a follow-up visit and a suture removal at day 6 after the surgery, a portable negative pressure wound therapy system was applied successfully and used until the wound was fully healed.
A dressing change was performed at each follow-up visit (4 times) and 3 pumps and 6 dressings were used in total. Sharp debridement was performed at all visits, except during visit 4 and the final visit.
At the last visit, the NPWT system was discontinued and the occupational therapist provided the patient with a silicone sheath to protect his thumb as the only further treatment.
No antibiotics were administered after the portable NPWT was implemented.
Outcome
Review at the baseline visit found no necrotic tissue. A majority of the wound was granulated (70%), with slough present (20%) and 10% of the wound had epithelialised.
7 days after starting the treatment with the portable NPWT, 20% of the wound had epithelialised and 80% was granulated. No slough or necrotic tissue was present.
The wound area decreased from 1 cm x 2 cm at the baseline visit to 0.1 cm x 0.3 cm at visit 4 .
19 days after the accident (last follow-up visit), 90% of the wound had epithelialised.
As the healing had progressed faster than expected and the thumb was forming satisfactorily, the planned follow-up surgery was not needed.
There were no clinical signs of infection during the treatment period. The surrounding skin appeared continuously healthy throughout. The canister fluid was clear and non-viscous and the exudate levels were low throughout the treatment period.
The patient reported no pain before or during the dressing changes.
Performance
Despite being a difficult area to dress, the NPWT dressing remained fully sealed with no leakage alarms during the treatment. Furthermore, there were no additional dressing changes between visits.
Patient experience
The patient was satisfied with the treatment throughout the treatment period, feeling it was easy to understand and manage without any pain.
Product evaluation
In general, the clinician perceived the device overall as very good. Both the size and the conformability of the dressing were specifically noted.Kefexin is a registered trademark of Orion Pharmaceutical Co.
