Case Study 2

Case Study: Use of the Sussman Wound Healing Tool to Measure Wound Healing

Ms. DT was a diabetic patient living in a skilled nursing facility (SNF). She developed a pressure ulcer on the heel and was sent to the hospital for surgical debridement. Upon return to the SNF she was referred to physical therapy for help in wound healing. She is alert/confused and non-ambulatory for an unknown period of time. Her diabetes is controlled with medication and diet.

Assessment:

Figure 1A shows the measurement method used to determine the initial wound size on July 22. The clock method of measurement of the length from 12:00 to 6:00 and 9:00 to 3:00 was used as shown.

Figure 1A

Periwound tissue assessment:

1. Maceration of periwound tissue along proximal wound margins. 2. Wound edges are soft and irregular in shape.

Wound bed tissue assessment:

1. Surface of wound is predominantly covered with slough.2. Patches of granulation tissue are observed. 3. There is minimal exudate.

The PUSH tool was used to quantify wound healing status of during the course of care.

PUSH score consists of 3 elements:

1. Size: 42 cm2 area = 102. Tissue type: slough = 33. Exudate: moderate = 2

Total PUSH Score = 15

Evaluation: Wound healing diagnosis and pressure ulcer stage:

1. Chronic inflammatory phase2. Stage III pressure ulcer

Prognosis: wound will heal

Interventions:

Dressing: Transparent film dressing changed daily to maintain moist environment, promote autolysis and allow for electrical stimulation daily treatment.

Electrical Stimulation: 5x/week, direct application of electrode method (monopolar) for 60 minutes per Sussman Protocol in Chapter 23.

Figure 1B 11 weeks later (October 10)

Figure 1B

PUSH Score:

Size: 3 cm2 = 5

Tissue type: granulation = 2

Exudate: light = 1

Total PUSH = 8

Periwound tissue assessment:

1. Epithelialization - remodeling 2. Absence of maceration 3. Skin turgor restored4. Wound edges are soft

Wound tissue assessment:

Wound bed has filled in to surface with granulation tissue, and epithelialization and contraction are progressing.

Electrical stimulation and transparent film dressings continued for 1 week when wound was 100% epithelialized and in remodeling phase.