L-Mesitran®
Case Study:C083
Post-operative wounds, SSI
A 44 year old female had scheduled surgery on September 10th
2008. She was in good general health, but had a crush injury to
both her feet previously. The bones were set in hospital in 2007
(see case C-080). The plan for surgery now was: a) removal of
screws from 1st metatarsals on both feet by opening the old scar
and stitching it internally along the same lines; b) bilateral excision arthroplasty of DIP joints of 2nd toes to correct deformity;
temporary stitches on the excision site to be removed in 3 weeks;
c) insertion of K-wire
Pic. 1 22/09/2008
Product: L-Mesitran® Ointment, Hydro, Border & Net
Case study done by: Zahra H. Pah-Lavan, BSc (Hons), BSc
(Dist.), RN, CRN, Emergency Nurse, United Kingdom
Method & observations:
The paraffine and gauze dressing that were used in theater after the surgery, were removed when the patient returned home
from the hospital on September 12th. Both wounds had bled
excessively and the gauzes stuck to the wounds. It took a lot of
soaking to remove the blood soaked gauze from the wounds.
From that point onwards the patient took photos. The patients
wound care plan included: - 2nd toes: L-Mesitran Ointment on all
wounds held by L-Mesitran Net, covered by non adherent gauze
or topped by L-Mesitran Border. - 1st metatarsals scar: L-Mesitran
wound Ointment, covered by L Mesitran Hydro.
The wounds were kept dry and the dressings were changed every 3 days, or as required. The patient was taking oral anti biotics
for polynephritis from 12 to 22nd September. She had the wires
and stitches removed on 24th September. The wounds were all
closed and healing till that point. Unfortunately the removal of
the stitches on the left 2nd toe was rather traumatic. Shortly afterwards, the increasing pain, pus and swelling proved an infection and the patient was put on 10 days of oral antibiotics. She
continued however with the above dressing regimen.
The patient returned to work on October 15th. Possibly because
of the recent structural changes to her toes and to increased
swelling following surgery, she developed multiple blisters between and beneath her toes and on the medial aspect of both
feet. Shortly after she returned to work the 1st metatarsals scars
on both feet showed signs of infection and pockets of pus developed at the wound edges.
The patient returned to application of L-Mesitran Ointment and
covering the wound with L-Mesitran Hydro dressing. This proved
successful and a week later the wounds appeared to be clean
and healing. Unfortunately the pockets of pus returned twice
more on the left foot and once again on the right. The same
treatment with the L-Mesitran ointment and dressing successfully dealt with the repeated infections. The patient did not take
more anti biotics as she suspected that the infection was on the
wound only and not affecting the bones.
L-Mesitran®
Pic. 2 25/09/2008
Pic. 3 03/10/2008
Pic. 4 20/11/2008
The wound on the left 2nd toe took longer than the right 2nd
toe to heal due to the infection following the removal of the suture site, but the above wound care saw the wound to its final
healed state. On November 20th the patient finally removed all
the dressings.
The patient experienced that the Hydro dressing was excellent in
pain relief when the wound was painfull and infected. The cool
feel of the dressing together with its cushioning effect allowed
her to continue to work without too much discomfort from the
1
L-Mesitran®
Case Study: C083
pressure from her shoes.
The scarring on the left foot of course reflects the repeated infections and as such appears wider. However, the patient discovered that with the left foot being infected repeatedly she needed
to use honey & dressing almost non stop. The final healing scar
on the non infected area of the left foot (mainly the middle of the
scar line) is smoother than on the (middle of the scar line) of the
same area of the the right foot where the nurse did not place any
dressing after the infection cleared.
Conclusion
Pic. 5 22/09/2008
This case study of post operative wounds after removal of screws
and insertion of K-wire in the feet of a previously crush injured
44 year old female patient was challenging. The patient was discharged from hospital and the wounds were dressed minimally,
i.e. paraffin or dry gauze only. The patient developed post operative infections that delayed wound healing and influenced scarring.
The overall prevalence rate of healthcare-associated infection
in the UK is 7.6% and increases significantly with age. Surgical
site infection is associated with recent surgery and antibiotic use
(Humphreys, 2008). As length of hospital stay after surgery continues to decline, a greater proportion of surgical site infections
will occur after discharge (Petheric, 2006). It seems that microbial
colonisation of both acute and chronic wounds is inevitable and
the risk of wound infection increases as local conditions favour
bacterial growth rather than host defence (Bowler, 2002). It is
therefore surprising that standard procedure in many hospitals
worldwide is still to discharge patients without taking preventive
measures in wound management.
The wounds described in this case study were critically colonized
and continued use of honey based ointment and dressings prevented further complications. It is interesting to see that in the
periods the materials were not used, infections returned, showing that materials should be used untill the wounds are fully
healed. In this case all wounds were healed in 56 days or less. The
wounds that had L-Mesitran on all the time showed less scarring
and faster healing than the wounds where the product use was
discontinued. The Mesitran products did not have any adverse
effects, dressing changes were easy and comfortable.
Declaration
This study was done independently and with the full consent of
the patient.
Pic. 6 25/09/2008
Pic. 7 01/10/2008
Pic. 8 20/11/2008
References
Bowler P (2002) Wound pathophysiology, infection and therapeutic options. Ann Med. 34(6): 419-27
Humphreys H et al. (2008) Four country healthcare associated
infection prevalence survey 2006: risk factor analysis. Journal of
Hospital Infection 69(3): 249-257
2
Petherick E, Dalton J, Moore P, Cullum N (2006) Methods for identifying surgical wound infection after discharge from hospital: a
systematic review. BMC Infectious Diseases 6: 170-180
L-Mesitran®