Title

APWCA2009 - Apr 04, 2009

Author(s)
 

Presented at: Philadelphia, PA

Background
A middle-aged farmer presented at our clinic in northern Ghana with a three-week-old third-degree chemical burn on the dorsum of his hand extending up his arm 17.5cm. With no prior treatment, the exposed tendons had become dark brown and foreshortened. Copious foul drainage dripped from an 8cm long tunnel. Surgical intervention, including skin grafting, was unavailable. After four weeks with only minimal improvement, our clinics petrolatum-gauze supply was exhausted. Dressings needed to reduce pain, be elastic (to stay in place), provide moisture to the exposed tendons and muscle, and absorb exudate from the tunnel while decreasing infection. Polymeric membrane dressings have demonstrated ability to reduce pain and inhibit infection, are flexible and donate moisture while absorbing excess drainage. The authors had observed immediate granulation tissue formation in previous stalled wounds using polymeric membrane dressings.

Methods
Treatment included teaching, prayer, oral antibiotics and direct wound care. Polymeric membrane dressings were changed when saturated. Heavy manual farming resulted in copious serous drainage, requiring daily dressing changes.

Results
The patient resumed farming shortly after treatment initiation, continuing throughout treatment. Granulation tissue formed quickly. Tendon and wound moisture became appropriate without infection spreading. Wound healing was slowed due to wound contamination and trauma during farming, inability to keep the hand elevated, poor communication resulting in non-compliance, a broken wrist, and severe protein malnutrition. None-the-less, the wound closed completely with an adequately functional hand and wrist in 56 weeks.

Conclusion
Polymeric membrane dressings provided effective wound management for this large third-degree chemical burn.