Chronic pressure injuries present a significant challenge in the home health care setting. Despite the use of standard wound care practices such as offloading and pressure distribution, these wounds may take a long time to heal and patients and their families often give up hope. Moreover, there is a dearth of evidence-based practice specific to this setting, so providers must rely on trial and error, underscoring the need for sharing best practices and disseminating knowledge in this area.
To make matters worse, many pressure injuries are located on the sacrum and can be complicated by undermining. Undermining is caused by erosion of the subcutaneous tissue under the edges of the wound and results in large and often deep wounds with a small opening. Pressure injuries are caused by unrelieved pressure that may decrease blood flow to the affected area; without proper treatment, these injuries can lead to tissue ischemia and necrosis.1 Complicated undermining, lack of blood flow, and low quality of life demand solutions to get these wounds to close.
One particularly useful product is Endoform (Hollister Incorporated, Libertyville, IL) dermal template. Endoform dermal template is a collagen dressing with an intact extracellular matrix (ECM).2 When placed in a clean wound where the patient’s ECM is damaged or missing, Endoform dermal template provides a temporary ECM scaffold the patient’s body can use to help grow new tissue.3,4 In addition, the product can help provide broad-spectrum matrix metalloproteinase reduction,5 useful for chronic wounds in which elevated protease levels may slow healing progress.6 Another major benefit of Endoform dermal template is that it incorporates into the wound, eliminating the need for removal and potential disturbance to the wound bed. Lastly, this advanced product is accessible and affordable in the home health care setting because it is reimbursable by Medicare as a collagen dressing.7
Overall, for the treatment of undermining, I am consistently finding that this collagen ECM dressing facilitates progress toward closure of wounds patients had given up on. This case is representative of a patient with pressure injuries admitted to my practice.