Management of Lower Extremity Hematomas Caused by Trauma In a Skilled Nursing Facility With a Super Absorbent Polymer Dressing

(SAPD*) With Or Without an Ag Oxysalts™ Contact Layer†

Aaron Wodash, BS, RN, CWON, CFCN, WCC

Problem:

Skilled nursing facilities regularly manage their Resident’s traumatic wounds as a result of falls, bumping into objects, and other minor accidents. Advanced age, co-morbidities, anti-coagulant therapy, and other medications, as well a residential living environment makes this population at risk for delayed healing and infection.

Current State of Practice:

Standards for wound assessment are well established, yet assessment alone does not guide dressing selection1. Furthermore, CMS Surgical Dressing Policy classifies wound care products based on ingredients, not function.2 Therefore, the provider must balance dressing selection to achieve clinical outcomes in addition to knowing the requirements for the payer source and managing cost.

Goals of Care:

Acute wounds tend to drain due to the inflammatory phase of wound healing. The congealed blood and non-viable tissue requires conservative sharp debridement, continuing inflammation and higher exudate levels. Our goals of care consist of prevention of infection, debridement of non-viable tissue, management of exudate, provision of a moist wound healing environment, manage pain, minimize dressing change frequency, and to minimize the risk of recurrent injury.

Previous Treatments:

The core of wound product selection is based on the assessment of the wound depth and exudate, goals of care, and function of the dressing. Prior cases with a similar presentation would be managed with honey hydrogels, silver and non-silver alginates, and silicone foam dressings with varying degrees of success.

Proposed Solution:

Manage hematoma with ulceration by conservative sharp debridement, a primary Ag Oxysalts™ contact layer dressing if signs and symptoms of infection were present, covered by a non-adhesive SAPD*, and secured with a gauze roll. Dressing changes were completed weekly or as needed due to slippage, strike through, or clinical preference.

Results:

Three patients were managed with the proposed solution. Expected outcomes were achieved within 2-3 weeks with weekly or bi-weekly dressing changes. One case showed significant epithelialization in one week.

Conclusion:

The combination of dressings along with conservative sharp debridement proved effective in managing hematoma ulcerations and achieved expected outcomes.

* KerraMax Care is a Registered Trademark of Crawford Healthcare LTD† KerraContact™ Ag Crawford Healthcare , Doylestown PA Ag Oxysalts™ are a trademark of Exciton Technologies

References1. Beldon, P. (2011). Haematoma: Assessment, treatment and management.

Wound Essentials, 6, 36-39. 2. Black, J. M. & Black, S. B. (2012). Reconstructive surgery. In R. A. Bryant & D. P. Nix, (Eds.), Acute &

chronic wounds: Current management concepts, 4th ed, (460-475). St. Louis, MO: Elsevier.

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Crawford Healthcare Inc. | 2005 South Easton Rd. | Suite 203 | Doylestown, PA 18901Tel 855-522-2211 | Email us.info@crawfordhealthcare.com | www.crawfordhealthcare.com/us

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Case #1 – Left Shin

Case #2 – Left Knee

Case #3 – Right Shin

10/23/14 – Initial Treatment was a silicone foam dressing.

10/30/14 – At this point SAPD* and Ag Oxysalts™ were initiated

11/6/14 11/20/14 12/3/14 – Complete closure in 41 days

11/7/14 –Post-Debridement

11/13/14 11/17/14 – Achieved 1 week wear time

11/24/14 – 7 day wear time with the combination of dressings

12/1/14 – The wound reached closure on 1/7/2015

1/7/15 – Dressing combination applied

1/8/15 – Marked infl ammation reduction day 1

1/15/15 – Weekly dressing changes continued

1/22/15 – Marked reduction in slough and increases in granulation

1/27/15 – Lateral size reduction seen typically seen in leg ulcer healing

2/5/15 2/12/15 2/19/15 – 7 weeks and 8 dressing changes until healing

11/7/14 –Pre-Debridement

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