A 16-year-old female patient receiving palliative care due to terminal malignancy was admitted to the Hematology Oncology Department for an infected central port in the upper left arm. Initial treatment of the infection was attempted without removing the port, but progressive cellulitis developed around the port area with progressive swelling, edema, and erythema. There were concerns about spreading systemic infection. The port was taken out, and the pocket was packed with tape, only to persistently drain serosanguinous exudate. The affected area remained tender, warm, and erythematous. Culture results were positive for methicillin-sensitive Staphylococcus aureus.
The author was consulted about wound management. Physical examination revealed the periwound area to be warm, erythematous, swollen, and very painful when touched. The patient wanted to go home because it was the pre-Christmas season and likely to be her last. Unfortunately, the wound was infected and resistant to granulation tissue growth (most likely due to overlying biofilm and suppressed proliferative stage secondary to various medications). In the past, the patient had experienced resistance to various antibiotics, which is a common occurrence in patients with frequent hospitalizations.
It was decided to use Cutimed Sorbact (BSN Medical, Charlotte, NC) hydrophobic antimicrobial dressing in 2 ways. The hydrophobic ribbon was used as packing material (Figure 1A), and Cutimed Siltec (BSN Medical) was used as an atraumatic, antimicrobial secondary dressing (Figure 1B). Dressings, including the packing, were changed on days 2 and 5. By day 5 the pain had subsided; swelling, erythema, and exudate diminished greatly; and granulation was visible (Figure 1C). The wound was packed again, and the patient was sent home. She was seen in an outpatient clinic 5 days later, at which point the pocket was smaller and partially filled in with granulation tissue; in addition, the patient no longer complained of pain.