Silflex soft silicone wound contact dressing: Case study 4
Pam Cooper, David Gray, Fiona Russell and Sandra String fellow are Clinical Nurse Specialists; Melvyn Bertram, Kristine Duguid and Gail Pirie are Tissue Viability Nurses at the Department of Tissue Viability, NHS Grampian, Aberdeen
Case report 4
A 57-year-old lady with a complex past medical history was referred to the tissue viability department after several operations. Her initial surgery was a popliteal bypass grafting to her right leg (27 March, 2009). This failed and she had to have a below-knee amputation (31 March, 2009). She was experiencing lower abdominal pain (1 April, 2009) and, as she had a history of ulcerative colitis, her medication was being reviewed at this time. Unfortunately she needed surgery (16 April, 2009) as she had a perforated colon and required a sub-total colectomy, ileostomy and mucous fistula.
Review 1
Figure 1. First assessment post-surgery by tissue viability. Topical negative therapy was started with Silflex soft silicone dressing covering the sub-mucous fistula at the base of the wound.
Post-surgery, the surgeon left the wound open as she also suffered from peripheral vascular disease and type II diabetes. Her condition at this time was poor. She was ventilated and there were signs of peripheral shutdown of her circulatory system. She was to be commenced on total parental nutritional therapy (TPN). The tissue viability nurse reviewed her wound with the consultant on 20 April, 2009 (Figure 1). The sub-mucous fistula was in the base of her wound. Due to the complexity of her condition, dressing options were discussed and it was decided to use topical negative pressure (TNP) therapy with Silflex (Advancis Medical) to occlude the sub-mucous fistula at the wound base. The wound measured 23.4 x 4 x 2.5cm. The wound bed had a dark blue colouring with a fibrinous covering. The Talley Venturi™ pump system was used at a setting of 80mmHg continuous therapy. Dressings were changed every three days.
Figure 2. Silflex soft silicone dressing at the base of the wound.
Review 2
At second review (13 May, 2009) the wound measured 19 x 6.5 x 5cm. The wound bed consisted of 40% slough and 60% granulation tissue. Exudate levels were medium volume with medium viscosity and there was no odour coming from the wound bed. The Silflex dressing was halved, then halved again to ensure occlusion of the fistula. In Figure 2 the dressing has opened up, whereas it should be folded in half to only cover the base of the wound. The patient remained intubated and on TPN feeding. Her extremities were oedematous and she remained in the intensive care unit. She was now alert and aware of being in hospital. There had been a significant improvement in her wound and general condition. Wound therapy continued
as before.
The Silflex dressing was effective in occluding the sub-mucous fistula and the staff found it easy to apply. Review was scheduled again for one week’s time.
Review 3
At the final review the wound measured 23.5x7x3.5cm (Figure 3). The wound bed consisted of 30% slough and 70% granulation tissue. Exudate levels were medium volume low viscosity and there was no odour from the wound. As before, the Silflex dressing had proved a good dressing for occluding the sub-mucous fistula without effecting the promotion of granulation tissue to the wound bed. The wound had continued to progress with the topical negative therapy. There was a plug of tenacious slough that was slightly slow at debriding (top of wound near sternum; Figure 3). Larval therapy may be an option at the next review to remove this. The patient was now breathing independently with limited ventilation assistance and was tolerating small amounts of diet with enteral supplements.
Figure 3. Final review of Silflex soft silicone dressing. The mucous fistula discharge can be seen on the surface to the left of this image.
Conclusion
The purpose of Silflex soft silicone wound contact dressing was to occlude the sub-mucosal fistula without causing any trauma to the surrounding tissues. The dressing was easy to use and performed the task required of it in this complex wound.
CONCLUSION
These case reports illustrate the clinical benefits of using Silflex soft silicone wound contact layer. The majority of patients were elderly, a factor which not only impacts on healing, but often means that the skin is fragile. Being soft and conformable with a high tensile strength, Silflex can be inserted into wounds which do not have uniform dimensions, and the clinician can be sure of retrieving the dressing in tact.
In three cases, Silflex was used in conjunction with negative pressure wound therapy (NPWT), and prevented adherence to underlying tissue while promoting healing.
The dressing was also used successfully in heavily exuding wounds, allowing the passage of exudate into the secondary dressing, while remaining in situ and allowing the secondary dressing to be changed without causing trauma to the wound bed.
The dressing performed well in all of these cases, and the patients were positive about the product in terms of reducing pain at dressing change.
Many of the patients had particularly friable skin and, again, Silflex played a key role in protecting the skin from further damage.
As we are presented with more and more complex chronic wounds, dressings such as Silflex will become more necessary to prevent secondary damage to the wound bed and surrounding skin, and to reduce trauma and pain during dressing removal.