Wound Care in the First Person: Collaborating with WOC Nurses to Optimize Patient Progress

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Karen Edwards MSS, RN, BSN, CWOCN University of Alabama Hospital, Birmingham AB

Given the complexity of the patients, inpatient wound care is challenging; therefore, all physicians and surgeons should work with their wound, ostomy, continence (WOC) nurses as part of a multidisciplinary approach. Poor management of inpatient wounds has serious implications in terms of slowing or holding subsequent treatments and transfers/discharges that can lead to increases in the length of stay, which impact health care resources utilization and costs. 

One tool I use for inpatient wounds is Endoform Dermal Template (Hollister Inc, Libertyville, IL). I appreciate its versatility and its ability to be used in stagnant or acute wounds and in situations where other advanced wound modalities may not be possible or optimal. In acute wounds where the patient’s extracellular matrix (ECM) is damaged or missing, Endoform Dermal Template provides a temporary ECM scaffold the patient’s body can use to help grow new tissue.1-3 In addition, the product can help provide broad-spectrum matrix metalloproteinase (MMP) reduction,4 useful for chronic wounds in which elevated protease levels may slow healing progress.5 Another important consideration for inpatient wound management is the continuum of care; using a dressing like Endoform, which is fully accessible in all settings, minimizes costly interruptions in the care continuum.

The following case is representative of the ways Endoform Dermal Template is an important part of the wound care armamentarium.

Case report. The patient was an 88-year-old woman with an acute wound and with coronary artery disease, hypertension, peripheral artery disease with iliac stents, additional multiple comorbidities, and a complex medical history. She was referred for care of her surgical incision following a transaortic transcatherer aortic valve replacement; the open sternal wound had undergone 2 to 3 surgical debridements. The wound was treated previously using negative pressure wound therapy (NPWT) for 1 week. The wound measured 10 cm x 6 cm x 2 cm with bone and wires visible; large denuded areas on her upper chest measured 10 cm x 10 cm, and drainage under the NPWT drape had caused maceration and breakdown. The patient’s pain level was 9 on a visual analog scale, particularly in denuded areas. Endoform Dermal Template and Hydrofera Blue foam (Hollister Inc) were applied (see Figure 1). owm_0518_edwards_figure1

Two (2) weeks later, the wound measured 10 cm x 5 cm x 2 cm, the wound bed was red and healthy, and sternal bone and most of the wires were granulated over. The patient’s pain level was 2 with dressing changes. We continued using Endoform and Hydrofera Blue Ready foam twice weekly, and we were able to transfer the patient to a rehabilitation facility. The wound continued to decrease in size over 1 week (see Figure 2); most of the wire was covered with granulation tissue. At this point, the patient was discharged with home care. owm_0518_edwards_figure2

At 7 weeks (see Figure 3), there was no pain associated with wound care. Endoform Dermal Template remained in the wound bed, and Hydrofera Blue Ready foam was changed twice weekly until wound closure was achieved 2 weeks later. owm_0518_edwards_figure3

In my experience, it is crucial to collaborate with other services/disciplines, utilize the appropriate resources to minimize complications and facilitate patient recovery, and move patients to their next phase of treatment as quickly as possible. Physicians and WOC nurses can work together to ensure aggressive wound management is applied from the start to prevent problems and optimize patient progress throughout treatment. 

References

1. Endoform Dermal Template Instruction for Use. Libertyville, IL: Hollister Inc; 2016.

2. Lun S, Irvine SM, Johnson KD, et al. A functional extracellular matrix biomaterial derived from ovine forestomach. Biomaterials. 2010;31(16):4517– 4529. doi: 10.1016/j. biomaterials.2010.02.025.

3. Irvine SM, Cayzer J, Todd EM, et al. Quantification of in vitro and in vivo angiogenesis stimulated by ovine forestomach matrix biomaterial. Biomaterials. 2011;32(27):6351–6361. doi: 10.1016/j.biomaterials.2011.05.040.

4. Negron L, Lun S, May BC. Ovine forestomach matrix biomaterial is a broad-spectrum inhibitor of matrix metalloproteinases and neutrophil elastase. Int Wound J. 2014;11(4):392–397. doi: 10.1111/j.1742-481X.2012.01106.X.

5. Gibson DJ, Schultz GS. Molecular wound assessments: matrix metalloproteinases. Adv Wound Care. 2013;2(1):18–23. doi: 10.1089/wound.2011.0359.

 

Wound Care in the First Person is made possible through the support of Hollister Inc, Libertyville, IL (www.hollister.com). The opinions and statements of the clinicians providing Wound Care in the First Person are specifi c to the respective authors and not necessarily those of Hollister Inc, OWM, or HMP. This article was not subject to the Ostomy Wound Management peer-review process.