The use of collagen and hyaluronic acid dressing in peristomal wound care

Miss Sunny Wu1
1RPAH, Camperdown, Australia

Aim: The aim of this poster is to review the use of a collagen and hyaluronic acid pad (Hyalo 4 Regen®) as a treatment option for the complication of a peristomal  wound in order to reduce hospital length of stay and expedite discharge home.

Body: Mrs W is a 64 year old female who underwent a Hartmann’s procedure with formation of a colostomy. A mucocutaneous separation was developed. It quickly deteriorated and was highly suspicious  as pyoderma gangrenosum.

Mrs R is a 64 year old female who underwent a right hemicolectomy with abcarian ileostomy formation. She developed a peristomal wound post-operatively.

Both of the patients were delayed for discharge because of the complications of peristomal skin. Then, the collagen and hyaluronic acid dressing was commenced as a primary dressing for both patients.

Conclusion: Mrs W’s peristomal wound was from 7 to 10 o’clock. The wound extended from stoma edge measured  2 x3 x2.5 cm. The shallow wound from 2 to 5 o’clock measured  1 x3 x 0.2 cm. After being treated with the collagen and hyaluronic acid dressing for 4 weeks, pt was discharged with this dressing.  6 weeks later, pt’s peristomal wound was epithelialized.

Mrs R’s peristomal wound at 9 o’clock measured 1 x1 x 1 cm. After being treated with the collagen and hyaluronic acid dressing for 3 weeks, the wound had completely granulated and had started to epithelialize. Pt was discharged soon after.


Biography:

Sunny Wu is a practising registered nurse at Royal Prince Alfred Hospital which is a designated centre for Pelvic Exenteration and Peritonectomy.  She has been nursing for 5 years with 3 years’ experience as a Colorectal Nurse. Currently, she is a master’s student of the Advanced G. I. Surgical Nursing Program at RPAH, and has been working in stomal therapy for the past year.

Bedside treatment of complex open abdomen

Ms Betty Brown1
1Royal Prince Alfred Hospital/Royal North Shore Hospital, Newtown, Australia

Care of a patient who had undergone 13 laparotomies for bowel obstruction and bowel perforation, with repeated failed attempts at ileostomy formation which resulted in multiple dehiscence and fistula formation.  He was transferred to our facility with short gut syndrome of ~ 150 cm bowel remaining, 4 perforations/fistulae, and grossly oedematous small bowel submerged in 2 litres of enteric bowel contents.

After debridement, Negative Pressure Wound Therapy (NPWT) was used with multiple contact layers to protect and separate the bowel.  After NPWT seal was obtained, fistula wound pouch was applied over the 4 fistulae to separate and monitor effluent. Dressings were changed 2-3 times weekly at the bedside with analgesia.

Patient developed complication of aggressive rare fungal infection within wound bed, treated with Veraflo therapy using hydrogen peroxide and aggressive serial surgical debridements.

Patient also had behavioural and family social issues which made his treatment and recovery challenging, and left against medical advice after 458 days of hospitalisation.

NPWT was continued until the wound was suitable for delayed primary closure and skin grafting.  He is now subsequently 95% healed and is now wearing a simple high output pouching system over his single fistula which had self-stomatised.


Biography:

Betty graduated with a Bachelor of Nursing on the Dean’s Honour list, from the University of Manitoba, Canada, in 2004.  She obtained her WOCNCB board certification in wound, ostomy, and continence nursing in the USA in 2010.  She has since worked as a wound and ostomy specialist nurse at top ranked hospitals including Johns Hopkins, Stanford University, Cleveland Clinic Abu Dhabi, Franciscan Health System, and  currently at Royal Prince Alfred Hospital and Royal North Shore Hospital in Sydney.  She has extensive experience in complex wound, ostomy, and fistula management, and is currently completing her Masters of Wound Care at Monash University, Victoria.

Effects of functional dressing for donor-site wound: A meta-analysis

Miss Shimin Liu1, Mrs Huiyi Tan2, Mrs Haiyan Li2, Miss Piaopiao Zhu1, Mrs Xuemei Ye2
1Jinan University, Tianhe District, Guangzhou City, Guangdong Province, China, 2GUANGZHOU RED CROSS HOSPITAL, Haizhu District, Guangzhou City, Guangdong Province, China

Objective: To evaluate the clinical effect of functional dressings applied to the donor site wounds using meta-analysis. Methods: Computer search PubMed, Cochrane Library, Web of Science, Ebsco, Chinese Journals Full-text Database, Wanfang Database, VIP Database, search date for the database from the self-built library up to April 2018, published in the relevant functional dressing treatment Literature on the wounds of the donor area. The measurement indexes were wound healing time, infection rate, and scar growth. Revman5.3 software was used for meta-analysis. Results: A total of 13 articles were included, including 984 patients and 1057 wounds. In the functional dressing group, the wound healing time was shorter than that of the traditional dressing group, with mean difference -2.31 (with 95% concordance interval -2.67~-1.94, P<0.00001). The incidence of wound infection in the functional dressing group was lower than that in the traditional dressing group, with relative risk (RR) 0.22 (with 95% confidence interval 0.10~0.51, P=0.0004). The scar score in the functional dressing group was lower than that of the traditional dressing group, with mean difference -1.06 (with 95% concordance interval -2.31~-0.89, P<0.00001). Conclusions: Compared with traditional dressing, functional dressing can accelerate wound healing, reduce infection rates, and reduce scar hyperplasia. Due to the quality of the included studies and sample limitations, the above conclusions still need to be verified by more high-quality research.


Biography:

Bio to come

 

Case Study: V.A.C ® therapy management of a complex ventral abdominal wound

Miss Kelly Vickers1
1Lyell McEwin Hospital, Elizabeth Vale, Australia

Introduction: Vacuum Assisted Closure (V.A.C®) Therapy has become a common wound care practice used in the treatment of surgical wounds, ulcers, skin grafts, burns, diabetic feet & fistulae. With its increasing use, particularly on complex wounds, clinicians sometimes need to adjust how it is used to ensure a positive patient outcome is achieved.

Background: A 65- year old female required a Hartmanns Procedure for a colovaginal fistula secondary to a diverticular perforation.  Complications such as a retracted stoma, wound breakdown and intra-abdominal sepsis lead to a further five surgical operations, resulting in a large ventral defect beneath the open wound. Other factors such as obesity (BMI 36.6kg/m2) and leaking stoma appliances further complicated her management.

Method: The large, irregular surface area of the wound, meant that V.A.C ® therapy was the most ideal option to heal this wound, but the large ventral defect in the abdominal fascia limited the use of high-pressure V.A.C ®, for fear of causing an enterocutaneous fistula. Using clinical judgement, low pressure V.A.C® therapy was initiated.

This case study outlines the challenges encountered when using V.A.C.® Therapy at low pressure suction, and the solutions created for successful wound healing.

Conclusion: By adjusting the application of low-pressure V.A.C ® to this abdominal wound, dressing leakages were prevented and attended to every 48-72 hours on the ward instead of being completed in the operating theatres. Initially it was planned for the patient to have a skin graft to the wound, but the wound healed without this additional surgery.


Biography:

Bio to come

Case report on effective use of Vacuum Assisted Wound Closure (VAC) system on a diabetic foot (heal ulcer)

Mr Upul Pathmasena1
1National Hospital- Sri Lanka, Colombo, Sri Lanka

Background: Heal ulcers are very complex, difficult to treat and it’s a great challenge to wound care practitioners. Delaying of wound healing is a significant burden to the patient, family, society and health care system especially in developing countries. Principle of therapy for heal ulcers is relief of pressure by off-loading, establishment of dermal micro circulation, correction of metabolic abnormalities, vigorous treatment of infections, good wound care with the treatments of the comorbidities and patient education. Even though the wound healing is slow, with provision of warm moist environment, wound healing could be accelerated. Vacuum Assisted Closure Systems have been shown to improve wound healing rates resulting in fewer amputations.

Case Report: This case report is on a successful treatment with Vacuum Assisted Wound Closure system on a poorly healing long standing diabetic fool ulcer of a 65-year old female patient. Initially the local hospital where she was treated had decided that she needs a below knee amputation as the calcaneum was exposed. At the time of presentation wound was two months old and there was evidence of active soft tissue infection.

A tissue debridement followed by application of a VAC dressing was used initially. After two rounds of VAC dressings lasting one week each, the wound condition improved significantly with good granulation formation. Subsequently the wound was managed with iodine and foam dressings which resulted in complete healing of the wound with fibrosis. Currently, 8 months after complete healing of the wound the patient remains fully ambulant.

Conclusion:   Vacuum Assisted Wound Closure Systems exhibits better wound healing rates, thus appeared to be a good alternative to conventional wound therapy in situations which otherwise would require an amputation.


Biography:

Born on August 1, 1967 in Colombo, Sri Lanka.

Entered School of Nursing Colombo in 1991. After successful completion of Nursing Education for 3 years, got appointed to the National Mental Health Institute Colombo.

Got certified in Enterostomal therapy from National Cancer Center South Korea in 2010 (WOCN)

Once completed the above, appointed as the WOCN in National Hospital Colombo and since then managing Stoma Care patients and conduct educational programs/workshops for medical students, student nurses etc.  Have attended World Union Wound Healing Society Conference 2016, Florence Italy and World Council of Entero Therapy Congress 2018 ( Kuala Lumpur, Malaysia)

AASTN

This conference is proudly hosted by the Australian Association of Stomal Therapy Nurses: www.stomaltherapy.com

One of the Association's major objectives is the promotion of quality care for a wide range of people with specific needs. These needs may be related to ostomy construction, urinary or faecal incontinence, wounds with or without tube insertion and breast surgery.

Patients/clients across the life span are provided with preventative, acute, rehabilitative and continuing care as required. Another objective is the maintenance and improvement of professional standards in relation to Stomal Therapy Nursing Practice to the highest degree possible. Recognition of the need for and encouragement of the development of specialist expertise in the field of Stomal Therapy Nursing underpins the Standards for Stomal Therapy Nursing Practice.

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