A new concept in the management of complex foot wounds: Case study 3

Lead Author - Linda Rafter, Tissue Viability Nurse Consultant, Honorary Professor in Nursing, DeMontfort University, Leicester 

Introduction

The Eclypse foot is a unique super absorbent dressing which is anatomically designed to fit around the foot. Eclypse foot is designed to absorb and retain large amounts of fluid and exudate and reduce the associated odour. The dressing contains a rapid wicking layer and 12 super absorbent compartments which lock away fluid into the dressing, reducing maceration and preventing re-infection from fluid leaking back on to the skin as it spreads the load across the dressing. The backing layer is a water resistant barrier and also prevents strike through, this is combined with a high moisture vapour transfer rate that allows breathability and prolongs wear time. The pre shaped foot allows easy application, thereby reducing the nursing time for dressing change and resulting in significant financial cost.

Method

Five patients were recruited from the inpatient and outpatient clinic in a general hospital. The ages ranged from 60 – 90 years. Patients were nominated by the ward staff and then the author visited them to ask them to volunteer to take part in the trial of the Eclypse Foot Dressing. She asked them for a contact number if they were going home to enable her to follow the patient up 14 days later. If they were still an inpatient the author I visited the ward to perform the follow up of information. The opinions of 20 nursing staff were also collected on the Eclypse Foot dressing. Fourteen days’ treatment was carried out where possible on each patient to enable a thorough evaluation of the comfort for the patient and if healing had taken place.

Case Study 3

Mr K was an 80 year old gentleman who had a right infected diabetic foot ulcer. He was known to have diabetes controlled by insulin, and a heart valve replacement some 30 years ago. His 2nd & 3rd toe on his right foot had been amputated in May 2011. He was is having a large amount of pain (9 on the Mccaffrey scale) and his pain killers were effective most of the time. On 12th September 2011 his wound was 3x2.5cms, and was full thickness and the wound bed consisted of 100% pink tissue. There was evidence of bone in the amputation site of the second toe space. The surrounding tissue was less cellulitic forefoot aspect. The planter surface was still very cellulitic. The wound on the outer big toe had decreased 2x2cms, appeared to be partial thickness and wound bed consisted of 50% pink and 50% yellow tissue (see figure 5). The author was able to feel posterior and anterior tibia pulses. His blood sugars were now more settled at 9.1 He had purchased a profiling bed frame and was able to elevate his legs at night.

Care Pathway

His care pathway was changed to Aquacel 15x15cms for the amputation sites and the outer ulcer and then Eclypse foot dressing secured with a bandage. On review on 26th September Mr K was having increased pain from his big toe (score Mccaffrey 9) and pain killers were not being effective as it kept him awake at night despite being on Morphine. On assessment the wound was 3x2.5cms i.e. full thickness, the wound bed consisted of 100% pink tissue and there was still evidence of bone in the amputation site of the second toe (see figure 6). The consultant reviewed the wound and agreed, following an x-ray to confirm this diagnosis, that the bone was infected and was connected to increase in pain. He scheduled Mr K to have removal of his big toe in the next two weeks. Mr K found the dressing uncomfortable and leaked a lot as the nurses were unsure how to apply the foot dressing. The increased pain may have been purely due to the infection in his bone and not due to this dressing.

Fig 5

Fig 6

Results

The results of five patient case studies will be reported in full in this poster and the patient outcomes. The patients experience on how they have found Eclypse Foot dressings was it comfortable and how it conformed to the patients foot.

Discussion

The new Eclypse Foot dressing appears to provide the optimum environment for healing. .It appears that the Eclypse Foot dressing helps to prevent infection and the fluid from is wicked away into the dressing. Nurses ordinarily used an Eclypse 20x30cm dressing which is not tailored to fit the patients foot for these complex wounds. The Eclypse Foot dressing provides an increased performance to manage the exudate appears and maintains the patient dignity.

Conclusion

The new Eclypse Foot dressing is an urgonomically designed suitable alternative choice for patients that suffer from toes that are about to auto amputate , gangrene, extremely wet feet and diabetic foot. Currently there are no dressings that address the issues like Eclypse Foot dressing by providing the optimum environment for patients that do not necessarily require their wounds to heal but need there foot to be kept dry. The Eclypse Foot dressing also delivers patient dignity as it gives them reassurance that Eclypse Foot dressing will encase their foot and wick the exudate into the dressing and prevent the embarrassing smell if the exudate leaks through the dressing on to their clothing.

References

Mc Caffrey M, Beebe A (1989) Pain A Clinical Manual for Nursing Practice St Louis, MO: CV Mosby Co