Case report - male - 77 years old
published: 19. 04. 2010
Kateřina Hanušová, nurse, University Hospital Hradec Králové, Emergency Ward
The patient was admitted on 18.3.2009 when he was after 5 days found at home after a fall to right half of body. He suffered pertrochanteric fracture of right tight bone and pressure ulcers on lower left limb (above trochanter II. – III. degree, 10×8 cm with central necrosis, lateral knee surface II. – III. degree, 15×8 cm continuing to lateral shin and ankle, above metacarpus two pressure ulcers III. degree, 3×3 cm). The patient was dehydrated and in very neglected status.
We started immediately with rehydration. Osteosythesis was perfomed on 19.3.2009. Operation was without any complication, operation wound healed per primam. In further development we paid attention mainly to sufficient food intake and provided the patient with Nutridrinks and Cubitan. The treatment of pressure ulcers was in cooperation with plastic surgeon. Necrectomy was performed and autotransplantation of skin was planned.
Our task was to clear ulcers bases for possible autotransplantation. On 27.3.2009 we started local treatment. First we applied Prontosan solution for 15 minutes and after thorough hygiene and treatment of surrounding we applied Hyiodine with Traumastem Biodress. After fixation of absorbent gauze layer we used Tegaderm. Rebandaging frequency was 2 – 3 days. Small necrectomy was performed in the first week. After 10 days we replaced gauze and Tegaderm with Biataine which has bigger capacity for exudate absorption. Thereby the rebandaging frequency was prolonged to 4 days. After 3 weeks, the plastic surgeon was called again. Effect of the local treatment was satisfactory so we decided not to perform skin autotransplantation. On 17.4.2009 we transferred the patient to LSH in Nový Bydžov. They continued in treatment with Flamigel and Betadine. By information of a treating doctor, 4 months after the injury the patient is almost recovered, walks with the walking frame and is in good physical state even good state of mind.
The patient evaluated this method of treatment as very positive. Most of all he appreciated analgetic effect of Traumastem Biodress. During hospitalization he was provided with analgetics minimally even immediately after operation.Costs on using of modern dressing might seem high, but my experience shows that time of healing is significantly shorter. Costs on these extensive pressure ulcers made 280,– CZK a day in average for 22 days.
Unfortunately, due to transfer the patient to another department and because he is not completely healed, it is not possible to calculate total costs. The advantage of modern dressing is the fact that the treatment is not time consuming and it is very comfortable for the patient during the treatment. Traumastem Biodress significantly helps with acceleration of healing and thanks to its analgetic effect remarkably improves quality of patients´ life.
