Episil Absorbent; treating a painful traumatic wound

Cathie Bree-Asian and Sylvie Hampton - Tissue Viability Consultants, Wound Healing Centre, Eastbourne.

Introduction

Mrs IR is an 87 year old lady who sustained a traumatic injury to the right
forearm. Initially this was treated by the Practice Nurse who had made good progress with the wound, but, after a period of 4 weeks, this progress halted and the wound became static. Mrs IR was referred to the Wound Healing Centre for intervention from the Specialist Nurses.

The wound was redressed on 3 occasions prior to the commencement of Episil
Absorbent, with the frequency of dressing changes being every 4-5 days due to strike through of exudate.

At the first application of Episil Absorbent, the wound measured approximately 4.1 I cm2

(Fig: I ).

Fig: I - The wound on day I of the
assessment The wound had been
bleeding and oozing copiously.

The wound had bled and therefore the nurses were unable to undertake the pH assessment. pH is an excellent indicator of healing as the pH of 6 to 7 is the optimum condition for healing (Hampton and Collins 2003).

Kaltostat was applied as a primary dressing to aid haemostasis. Episil Absorbent was applied as a secondary dressing over this. Mrs IR returned a week later for review of the wound. She stated that the dressing had been comfortable to wear and had remained in place well. On inspection the dressing had retained the exudates without strike through and the dressing came away easily without
any discomfort. Despite the fact that the surrounding tissues were very friable, the silicone adhesion of the dressing meant that the skin was not adversely affected during dressing removal.

Pain frequently is an overlooked aspect of wound care although it causes a physiological response and unresolved pain can have a negative impact on wound healing (Bechert, and Abraham, 2009). Studies show that more than 80% of patients with chronic wounds are in constant pain - and half of them classify the pain as moderate to severe (Gottrup et al 2008). A great deal of pain is associated with dressing removal and so a dressing that removes without trauma is optimum for reducing pain in painful wounds (Hampton and Collins 2003).Therefore, Episil Absorbent was ideal in the case of this lady with painful wounds and fragile skin.

The wound itself was still bleeding slightly but less so than at the previous dressing change. It measured 4.13cm2 with a wound bed pH of 7.25 and the peri wound showed evidence of re-epithelialisation with the wound bed pink and healthy and active. (Fig: 2).
Episil was applied.

Fig: 2 - The wound has
reduced in size and is clean
without maceration.

After a further week, Mrs IR returned to the Wound Healing Centre. The bleeding had now ceased and there was further evidence of wound progression. The wound had shrunk significantly in size to 2.46cm2 (Fig: 3).

Fig: 3 The wound has reduced
by / .652cms and shows
obvious signs of healing.

Again there was no trauma to the fragile tissues at either the peri-wound or the surrounding skin on removal of the dressing.

The dressing had retained what little exudate had been produced, had stayed in place well and remained comfortable for the patient over the course of the week.

Conclusion

The Episil Absorbent dressing locked away and retained the moderate levels of exudate experienced from this wound, without any leakage, and consequently facilitated a longer interval between dressing changes.

The patient reported that the dressing was very comfortable to wear and the dressing stayed in situ well. Most importantly, this patient has very fragile, friable skin and the Episil Absorbent did not cause any trauma on removal. Therefore, it can be concluded that the dressing is suitable for use on friable skin where other adherent dressings may cause trauma.

References

Hampton, S., Collins, F., (2003) Tissue Viability.A
comprehensive Guide
Bechert, K,Abraham, S£ (2009) Pain Management and
Wound Care The Journal of the American College of Certified
Wound Specialists I (2) 65-71
Gottrup et al. Reducing wound pain in venous leg ulcers with
Biatain lbu:A randomised, controlled double-blind clinical
investigation on the performance and safety. Wound Repair
and Regeneration 2008; / 6:6 / 6-626