Read 55047 MD Wounds Poster AW text version

55047 MD Wounds Poster AW

8/11/07

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Page 1

A Case Series: Managing Skin Grafts with Exsudex

Jacky Edwards ­ Clinical Nurse Specialist, Wythenshawe Hospital Introduction

Following the recent challenge to the patent of negative pressure, this has opened the flood gates for other Topical Negative Pressure (TNP) systems to be available in the market place. The concept of negative pressure drainage was first described by Chariker et al (1989)1, and it was this paper that enabled the patent to be challenged. However, the new systems are not able to use comparable foams as used in the VAC pumps (KCI), and have to rely on gauze in their systems. The Chariker-Jeter technique was described in 1989. The aim of the therapy is to convert an open wound into a controlled closed wound, whilst removing excess fluid from the wound bed, thus enhancing blood circulation and disposal of cellular waste from the lymphatic system (Fleck & Frizzell 2004)2. Rather than using a foam dressing, the Chariker-Jeter technique uses a layer of non-adherent gauze (KerlixTM) in the wound; a silicone drain is placed on the gauze and then covered with more gauze and drape. ExsudexTM is one of these Chariker-Jeter systems; it is a wound drainage system. It is based on a pump which delivers negative pressure at levels set by the user. The pump is lightweight and offers a wide range of negative pressure settings and can be used on many wound types. ExsudexTM is indicated for use on pressure ulcers, chronic wounds, venous/arterial ulcers, diabetic ulcers, infected wounds, acute and traumatic wounds, partial thickness burns, dehisced incisions, meshed grafts and flaps. In this case series, the ExsudexTM wound drainage system was used on a series of skin grafts. Take of skin grafts can be problematic in certain anatomical areas as well as in certain patients, i.e. elderly. Application of TNP ensures stabilisation of the skin graft as well as prevention of shear and seroma formation underneath the skin graft, thus preventing loss of skin graft and promoting skin graft `take' (Schneider et al 1998)3. In order to prevent adherence of the gauze to the graft, the graft must be lined with Mepitel, but this is also the case when using the foam with the VAC Therapy system.

TM

Conclusion

The system seemed to be as effective as using a foam based system. Good skin graft fixation and take was achieved, with no loss of skin graft on removal. The pump was used at 75mmHg and there were no pain problems. Patients were able to mobilise with the therapy in situ, which is imperative as commonly these elderly patients often have problems of immobility, whilst not jeopardising graft take. The pump is cheaper in terms of rental and consumables, but does require a bit more time and patience in its application. Given the proliferation of these gauze based systems on the market, a detailed evaluation of the systems is required, but this has opened up the market, which can only benefit the NHS as a customer and the patient, as these systems appear to be more affordable for the NHS to use.

Case Study 1:

86 year old lady with bilateral burns to her feet

Case Study 2:

Left foot

76 year old lady with full thickness burn to dorsum of foot

Right foot

1. Before debridement

2. With skin graft in situ

3. Application of ExsudexTM (KerlixTM and Silicone drain being sited)

4. More KerlixTM added

1. Prior to debridement

2. Post debridement

1. Pre debridement

5. Drape being applied

6. ExsudexTM in situ

7. Good take of graft

3. Skin graft in situ

4. Good take of graft

2. Post ExsudexTM, with good

graft take

References

1. Chariker, M. E., Jeter, K. F. et al (1989) Effective Management of incisional & cutaneous fistulae with closed suction drainage. Contemporary Surgery. 34: 59-63. 2. Fleck, C. A., & Frizzell, L. D., (2004) When negative is positive: a review of negative pressure wound therapy. Extended Care Product News. 3-4:20-25. 3. Schneider A. M., Morykwas M.J., Argenta L.C. (1998) A new and reliable method of securing skin grafts to the difficult recipient bed. Plast Reconstr Surg 102(4): 1195-8. Jacky Edwards ­ Clinical Nurse Specialist Acute Block, Wythenshawe Hospital, Southmoor Road, Wythenshawe M23 9LT mobile: 07866 485533 email: [email protected]

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