A new concept in the management of complex foot wounds: Case study 1

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 1

Mr W was a 79 year old male with history of long standing legs over the last two years. He was known to have hypertension, atrial fribulation, diabetes, renal failure, spondilitis and peripheral vascular disease. On assessment he had bilateral lipodermoscelrosis and pitting oedema, was unable to feel pulses and the oedema was solid up to his knees. He did have pulses at his knees and good capillary fill of his toes. On removal of the dressing the left inner ankle wound had decreased 12x10cms, the wound bed was covered in wet superficial ulcerations and was 50% yellow green and 50% pink tissue. His right foot was very wet around 3 toes, base was ulcerated through to the front of his toes and wound had increased 7x12 cms. The wound bed consisted of 50% yellow 100% pink tissue, appeared to have deteriorated since his last assessment and was considerably wetter with exudate. Mr W, the patient, informed his GP that he thought he had a veruca 1x1cms and that he had treated it and it had made a hole in his foot which had been there ever since.

Care Pathway

On the 29th September 2011 Mr W was advised to elevate his lower legs when possible. The care pathway for the right foot was changed to the new Ecylpse foot dressing with AG Sorbsan ribbon x 2, Acquacel was applied and wool toe to knee bandage was used on the toes (see figure 1). On his left inner ankle Aquacel 15x15cm was applied and Eclypse dressing every 3 days with reduced compression 3 layer K soft, K lite and K Plus as agreed by the vascular consultant.

Fig 1

Fig 2

Mr W was reviewed on 10th October 2011. On removal of the dressing, the left inner ankle wound had decreased into three separate wounds partial thickness 2x2cms,3x3cms and 5x2cms and the wound bed was far less wet and was 20% yellow green and 80% pink tissue (see figure 2). His right foot was far less wet around 3 toes and base was nearly healed. The front of his toes and wound had decreased 7x8 cms. The wound bed consisted of 100% pink tissue and the appearance had improved dramatically since his last assessment.. Mr W had found the new foot dressing comfortable and was happy that it had promoted the healing of his right foot very effectively. He did state that the nurses were confused on how to apply the dressing but that he had had a different nurse at each dressing change.

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