The use of Activon Tulle on an overgranulated grade 3 pressure ulcerThe use of Activon Tulle on an overgranulated grade 3 pressure ulcer
Anita Kilroy-Findley - Tissue Viability Nurse Mental Health, Leicestershire Partnership NHS Trust
Male, 66 years old with Korsakoffs syndrome, stable weight on supplements, very aggressive at times. Ward report it was a grade 3 pressure ulcer from ill fitting footwear that appeared to over granulate, initial phone advice said to use a foam, unclear why this didn’t happen. The dressing had not been changed for five days prior to visit, reported as IRF. The wound type was classified as complex due to its odd presentation on the second toe.
pic1
Review notes 01.10.2007
Healing: Yellow/red
Infection: Local
Exudate: Low/medium
Dressings used - Primary: Atrauman,
Secondary: Release
Infected - malodourous and friable, very wet, previous swab negative,
query anerobic infection, SHO looking at metronidazole course whilst await new swab results. Prescribed inadine and tegaderm foam non adhesive cut into a
T shape and folded round toe, foam will arrest over granulation and absorb exudate. Pics to be sent to TVN at UHL (University Hospitals Leicester) for opinion as not something seen by LPT TVN before to this extent. Not measured due to curvature. Suggested should speak to Consultant regarding referring for a biopsy.
pic2
Review notes 15.10.2007
Healing: Yellow/red
Infection: Local
Exudate: High/low
Dressings used Primary: Inadine
Secondary: Tegaderm Foam non adhesive
UHL suggested x ray to rule out osteomyelitis, done 5.10.2007, negative, agreed that next stage was biopsy, referral done by medics. Prescribed Activon Tulle for antiinflammatory effect. The toe remains friable but not malodourous, continue inadine as a temporary measure whilst awaiting honey from pharmacy, curvature made measurement impossible.
pic3
Review notes 18.10.2007
Healing: Red
Infection: Critically colonised
Exudate: High/low
Dressings used Primary: Inadine
Secondary: Tegaderm Foam non adhesive
An improvement in friability noted, awaiting dermatology appointment, Activon Tulle applied for anti-inflammatory effect on over granulation - this remains the working diagnosis until seen by dermatology, tegaderm foam non adhesive as secondary dressing, cavilon to peri wound and adjacent toes to protect from moisture damage, change daily, Modern Matron over seeing whilst I’m on annual leave.
Review notes 30.10.2007
Healing: Yellow/red
Infection: Colonised
Exudate: Medium/low
Dressings used Primary: ActivonTulle
Secondary: Tegaderm Foam non adhesive
Discussed with Staff Nurse, she said the toe is improving, went to dermatology last week but no biopsy as they didn’t have enough staff! Unable to visit as no car.
pic4
Review notes 11.11.2007
Dressings used Primary: Activon Tulle
Secondary: Tegaderm Foam non adhesive
Less raised in appearance, seen by dermatology, query squamous cell, awaiting biopsy results.
Review notes 20.11.2007
Healing: Red
Infection: Colonised
Exudate: Medium/low
Dressings used Primary: Activon Tulle
Secondary: Tegaderm Foam non adhesive
Discussed with SHO, biopsy result is clear, continues to respond well to anti inflammatory effect of homey, continue current care.
pic 5
Review notes 09.12.2007
Healing: Yellow/Red
Wound Dimensions Length: 0.9
Infection: Colonised Breadth: 0.7
Exudate: Low/Low Area: 0.63
Dressings used Primary: activon tulle
Secondary: Release
Significant contraction, healthy epithelium and surround, granulation is flat, small area of slough still to debride, ensure orthotic footwear worn to prevent further ulceration. Change primary dressing to non-adherent contact layer to protect healthy granulation and progress wound to healing.