Breast Reduction Dehiscence: Innovative Management of a Complex Wound Clinical Problem Description of Past Management Judy Burbage RN, BSN, CWCN Roper Saint Francis Home Care, Charleston, SC *Tritec™ Silver dressing. Milliken Healthcare Products, LLC [email protected] | healthcare.milliken.com | 1-866-491-6556 | 920 Milliken Road, Spartanburg, South Carolina, 29303 USA © 2013 Milliken Healthcare Products, LLC. All rights reserved. Tritec™ and Active Fluid Management® are trademarks of Milliken Healthcare Products, LLC. • A 54 year old female presented to our home care agency with a post-operative (25 days) dehisced surgical wound from a bilateral breast reduction. • The patient is 5’ tall and weight 75 kg and has a history of chronic back and neck pain, hypertension, and depression. • Patient presented with three different wounds: right breast, left breast and right nipple. Initially, the right nipple wound presented as 5 cm length x 3.5 cm width x 1 cm depth, brown slough with foul odor covering the wound bed. • Despite Negative Pressure Wound Therapy (NPWT) for two weeks, the nipple wound deteriorated to a depth of 9 cm with increasing drainage. The extended depth if the wound presented a challenge to provide adequate antimicrobial protection during NPWT. • The patient remained afebrile and without other signs or symptoms of infection throughout our episode of care. Reduction in Wound Size • Initially, all wounds were treated adequately with NPWT, but orders were given to replace NPWT with Dakins 0.25% soaks twice a day to the nipple wound along with serial debride-ments as needed. • The patient was unable to afford the Dakins solution from the pharmacy, so instructions and a recipe were provided. She made the solution and performed the wound care independently. • After two weeks of this treatment, the right nipple wound measured 4 cm length x 11 cm depth, with decreased slough but continued copious drainage. Clinical Approach • Antimicrobial treatment was provided by Tritec™ Silver strips (1” x 24”) cut to extend to the depth of the wound along with foam and NPWT. • The goal was to achieve antimicrobial coverage and wick drainage from the deep tunneling wound while ensuring complete removal of antimicrobial product with each dressing change. • Tritec™ Silver was the product choice that accomplished this goal Initial 3/01/06 4 x 4 x 11 cm 2 weeks 3/14/06 2.2 x 1.5 x 7 cm 3 weeks 3/22/06 3 x 1 x 6 cm 6 weeks 4/12/06 0.5 x 0.5 x 0.1 cm 176 23.1 18 0.025 0 50 100 150 200 0 2 3 6 Weeks of Treatment Wound Volume (cm^3) Customized Treatment Designs Tunneling Wound Tritec™ Silver 1x24” Strip (wrapped around foam) Adhesive Drape Foam Dressing NPWT Conclusions • After two weeks of therapy with Tritec™ Silver and NPWT, the right nipple wound measure 2.2 cm length x 1.5 cm width x 7 cm depth with pink wound bed and edges. • Drainage and odor decreased substantially so this wound care regime was extended for another two weeks. • The wound measurements at final discharge were 0.5 cm x 0.5 cm with minimal wound depth. • Utilizing an alternative wound care regime of Tritec™ Silver with NPWT, we obtained substantial wound closure, as well as management of drainage and bacterial bioburden of a deep tunneling wound. •The patient discharged to self-care and follow-up care with physician TRITECCS08r01

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Page 1: Breast Reduction Dehisance - Milliken & Companyhealthcare.milliken.com/en-us/Documents/Breast Reduction Dehiscence...Breast Reduction Dehiscence: Innovative Management of a Complex

Breast Reduction Dehiscence: Innovative Managementof a Complex Wound

Clinical Problem

Description of Past Management

Judy Burbage RN, BSN, CWCNRoper Saint Francis Home Care, Charleston, SC

*Tritec™ Silver dressing. Milliken Healthcare Products, [email protected] | healthcare.milliken.com | 1-866-491-6556 | 920 Milliken Road, Spartanburg, South Carolina, 29303 USA© 2013 Milliken Healthcare Products, LLC. All rights reserved. Tritec™ and Active Fluid Management® are trademarks of Milliken Healthcare Products, LLC.

• A 54 year old female presented to our home care agency with apost-operative (25 days) dehisced surgical wound from a bilateral breast reduction.

• The patient is 5’ tall and weight 75 kg and has a history ofchronic back and neck pain, hypertension, and depression.

• Patient presented with threedifferent wounds: right breast, left breast and right nipple. Initially, the right nipple wound presented as 5 cm length x 3.5 cm width x 1 cm depth, brown slough with foul odor covering the wound bed.

• Despite Negative Pressure Wound Therapy (NPWT) fortwo weeks, the nipple wound deteriorated to a depth of 9 cm with increasing drainage. The extended depth if the wound presented a challenge to provide adequate antimicrobial protection during NPWT.

• The patient remained afebrile and without other signs orsymptoms of infection throughout our episode of care.

Reduction in Wound Size

• Initially, all wounds were treated adequately with NPWT, but orders were given to replace NPWT with Dakins 0.25% soaks twice a day to the nipple wound along with serial debride-ments as needed.

• The patient was unable to afford the Dakins solution from the pharmacy, so instructions and a recipe were provided. She made the solution and performed the wound care independently.

• After two weeks of this treatment, the right nipple wound measured 4 cm length x 11 cm depth, with decreased slough but continued copious drainage.

Clinical Approach• Antimicrobial treatment was provided by Tritec™ Silver strips(1” x 24”) cut to extend to the depth of the wound along with foam and NPWT.

• The goal was to achieve antimicrobial coverage and wickdrainage from the deep tunneling wound while ensuring complete removal of antimicrobial product with each dressing change.

• Tritec™ Silver was the product choice that accomplished this goal

Initial 3/01/06 4 x 4 x 11 cm

2 weeks 3/14/06 2.2 x 1.5 x 7 cm

3 weeks 3/22/06 3 x 1 x 6 cm

6 weeks 4/12/06 0.5 x 0.5 x 0.1 cm

176

23.1 180.025

100

150

200

0 2 3 6

Weeks of Treatment

Wou

nd V

olum

e (c

m^3

)

Customized Treatment Designs

TunnelingWound

Tritec™ Silver1x24” Strip

(wrapped around foam)

AdhesiveDrape

Foam Dressing

NPWT

Conclusions

• After two weeks of therapy with Tritec™ Silver and NPWT, theright nipple wound measure 2.2 cm length x 1.5 cm width x 7 cm depth with pink wound bed and edges.

• Drainage and odor decreased substantially so this wound careregime was extended for another two weeks.

• The wound measurements at final discharge were 0.5 cm x 0.5cm with minimal wound depth.

• Utilizing an alternative wound care regime of Tritec™ Silverwith NPWT, we obtained substantial wound closure, as well as management of drainage and bacterial bioburden of a deep tunneling wound.

•The patient discharged to self-care and follow-up care withphysician

TRITECCS08r01