Debridement of Burn Tissue and Dressing with 100% Manuka Honey and Telfa Clear

Barry Noble Senior Charge Nurse, Burns Unit

Introduction

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Patient and Wound

• 88 yr old Gentleman.
• Collapse at home and lay in front of fire for ? 12 hours.(un-witnessed).
• PMH - Depression, Hypertension.
• Social – Meals on wheels, some help from elderly cousins.

On Admission 16.08.10

• Dehydrated, confused, incontinent of urine.
• Informed that amputation might be end result. (Patient not willing to make that decision)

Surgery

• 08.10 Debridement of Burn Tissue and Dressing with 100% Manuka Honey and Telfa Clear.
• Daily dressing.
• Microboilogical screening
• Bloods
• Counselling
• Still unwilling to give consent for amputation.

• Continued use of 100%Manuka honey and non-adhesive dressing.
• Knee becoming more necrotic.
• Rest of wound remains clean in appearance and not smelling offensive

White Blood Cell Count     (109/l)

• 08.10 (on admission) 13.08
• 08.10                          8.5   
• 08.10                          7.7   
• 08.10                          10.05
• 08.10 (post operative) 14.6 
• 09.2010 (discharge)     6.7   

Microbiology.

16.08.10 (admission)                Bacillus isolated

19.08.10                                   Bacillus isolated

24.08.10                                   Bacillus isolated

25.08.10 (Amputation Performed, continue to dress stump wound with Manuka Honey).

29.08.10                                   No Growth

31.08.10                                   No Growth

03.09.10                                   No Growth

• 09.2010 left above knee amputation.

• Short term rehabilitation on ward.

• Transfer to local hospital for ongoing rehabilitation and ‘limb fitting’ referral.

• Follow up in Scar Review and Consultant clinics.

Clinical Objectives

• Prevent local Infection leading to systemic sepsis.
• Allow time to counsel patient to give informed consent for appropriate surgery.
• To spare as much viable tissue as possible.
• To protect remaining limb function.

Challenges in wound management

• Pain
• Sepsis
• Protection of compromised structures
• Psychological wellbeing

Benefits

• Control of microbiology
• Protection of compromised structures
• Window of opportunity for clinical decision to be made

Conclusion

It is not always possible to save an effected limb from a deep burn and it is a very difficult decision for the individual to give consent for amputation.

We were able to delay the Amputation of the limb whilst the patient came to terms with the idea, offering counselling and support in un-hurried way.

It was possible to delay the surgery because we were able to keep the debrided wound free from infection and the patient remained asymptomatic from sepsis.