Wounds International, Vol 1; Issue 1Case studiesManagement of a large necrotic neck wound

Management of a large necrotic neck wound

09/11/09 | Pressure ulcers | Lisa Ooi Lay Theng

 

Five weeks later: At follow-up five weeks later, the wounds were healing well (Figs 11 and 12) and the depth of the main wound had reduced by approximately 3cm to the left and 2.5cm to the right. The wounds were again dressed using a hydrogel foam dressing. This was felt to be an appropriate choice for a granulating cavity wound as it is able to donate moisture when needed as well as absorb exudate in wetter wounds [4].

Figs 11 and 12

Figure 9Figure 10

  

Pain management

This was an area of care that was not well managed for a number of reasons including Mrs A's allergy to many of the available analgesics (see Box 1). Mrs A was very brave and tolerated the dressing changes and the draining of the fluid well, although she clearly found them distressing. The UCT had not anticipated the extent of fluid drainage and managed the situation using verbal support and distraction techniques during the procedure. It is acknowledged that more attention to pain management using formal pain assessment tools would have improved Mrs A's care and the use of Entonox should have been considered.

 

Limitations

As a non-profitable charitable hospital, patients pay according to their means and the money paid by the more affluent patients is pooled back into the hospital resources. There are times when patients need to be transferred to the government hospital where their medical expenses can be fully subsidised by the Malaysian government.

 

CONCLUSION 

Despite resistance to change from a number of departments, the UCT is becoming established as a recognised and valuable resource within the hospital. This is helped by the fact that the surgeon treating Mrs A was enthusiastic about the service and had attended a seminar on the latest technologies in wound healing. The head of the UCT is planning to develop a national wound care society and to drive the case for tissue viability to become a recognised speciality within healthcare in Malaysia.

 

Author details:

Lisa Ooi Lay Theng, SRN, Dip Nursing, Malaysia. Lisa is currently studying for BSc (Hons) Clinical Nursing, University of Hertfordshire, UK

References

  1. Kahn JH. Retropharyngeal abscess. Emergency Medicine 2008. Available from http://emedicine.medscape.com/article/764421-overview (accessed September 2009).
  2. Bell J. Are pressure ulcer grading and risk assessment tools useful? Wounds UK 2005; 1(2). Available from http://www.wounds-uk.com/cgi-bin/journal_view_abstract.cgi?articleid=0102_grading
  3. Chaby G, Senet P, Vaneau M, et al. Dressings for acute and chronic wounds: A systematic  review. Arch Dermatol 2007; 143 (10): 1297-304.
  4. Wound Care Handbook 2008-2009. The comprehensive guide to product selection. London:  MA Healthcare,  2008.
  5. Gardner SE, Frantz RA, Saltzman CL, et al. Diagnostic validity of three swab techniques for identifying chronic wound infection. Wound Repair Regen 2006 Sep-Oct;14(5):548-57.

 

Page Points

  • At five weeks following discharge, the wound was healing well
  • A hydrogel foam dressing was used to help granulate the cavity wound
  • Improved pain management strategies including the use of formal pain assessment tools would have improved the care of this patient
  • The ulcer care team (UCT) is becoming established as a recognised and valuable resource within the hospital