Is Your Wound Bioburdened? Case 2

CASE & INITIAL EXAMINATION

• 50-year-old male with morbid obesity visiting the outpatient wound care center for bilateral lower extremity wounds and lymphedema. Click here for photo.
• The wound on his leg was present for several months and previously treated with broad spectrum oral antibiotics for cellulitis. Click here for photo.
• Pain, odor and erythema detected from wound, prompting the clinician to perform a fluorescence scan. Click here for photo.

CLINICAL DECISION

• Scans and videos revealed bright red fluorescence indicating significant pathogenic bacterial burden in the wound bed. Click here for photo.
Click here to view a video of this case.
• The wound and surrounding tissue were cleansed with soap and water followed by hypochlorous acid to eliminate red fluorescence caused by bioburden.
• The patient was unable to tolerate sharp debridement of thick hyperkeratotic plaques and crusted drainage so mechanical debridement with a microfiber pad was used to reduce bioburden and necrotic tissue. Click here for photo.

OUTCOME

• The images and video revealed the propensity for lymphatic fluid to foster high bacterial loads and the importance of thoroughly cleaning the wound bed and mobilizing the lymph to hinder bacterial replication. Click here for photo.
• Based on the images and videos taken post-debridement an oral suppressive antibiotic agent was prescribed to manage recurrent cellulitis, pain and odor. Click here for photo.
• Initiation of suppressive antibiotic therapy without delay has reduced risk of sepsis and avoided recurrent cellulitis and hospitalization.

Laura Swoboda, DNP, APNP, FNP-C, CWOCN-AP, is affiliated with Froedtert & The Medical College of Wisconsin, Menomonee Falls, WI.

Click here to download a PDF of this article.