Watch Richelle Roethler Present the Treatment Plan for a Pilonidal Cyst Removal

In this presentation, Richelle Roethler, RN, APN, FNP, CWCN-NP, describes her treatment plan for a 40-year-old man with a surgical wound, which was left to close by secondary intention, located on the coccyx. 

This video was sponsored by ConvaTec.

Transcription:

Wound hygiene protocol was initiated at the start of my treatment plan, and during each visit, wound was cleansed with an antiseptic wound cleaner through the area approximately 15 cm from the edges. After each debridement and refashioning of the wound edges, wound was again thoroughly cleansed with normal saline and soaked with an acetic acid soak for 5 to 10 minutes.

The patient returned to the wound center at week 3, did not re culture the wound as it was healing as expected. He presented with no signs and symptoms of infection. Understanding the literature tells us approximately 78% of hard to heal wounds contain biofilm,^1-3 wound hygiene was continued.

This time, I discontinued gentamicin antibiotic ointment as antibiotic overuse contributes to antibiotic resistance. I changed the dressing through AQUACEL Ag Advantage because of its ability to wick away moisture and its MORE THAN SILVER antimicrobial properties, covered with gauze and a waterproof transparent film, and was changed daily.

I share this case with you because, oftentimes, providers think of AQUACEL Ag Advantage for wounds such as diabetic ulcers or venous stasis ulcers. It’s also an excellent option for any wound that is moderately to heavily exudating or to control wound and periwound excess moisture as in the case of this patient's wound.

This large surgical wound affected his quality of life and his wellbeing. Wound healed within 3 months of treatment, utilizing the wound hygiene protocol, with the patient and his wife doing the dressing changes at home.

He and his wife were very receptive to wound hygiene and diligent with cleaning, extending, end of 15 cm from the edges, dressing changes, and lifestyle modification. His wife was diligent, using sterile gauze with each cleaning, avoiding cross contamination with the rectum, which could introduce unwanted bacteria into the wound bed.

Wound debridement and refashioning to the point of endpoint bleeding can cause some discomfort. He understood it was necessary to remove unwanted, devitalized tissue and biofilm for healing. He reported experiencing diaphoresis around the wound and understood it was a prime environment for microbial growth, having experienced 2 prior wound infections.

Choosing a dressing to further prevent infection was especially important to him and his wife. AQUACEL Ag Advantage was an ideal dressing choice for its ability to manage biofilm within the dressing, its unique formula, consisting of BEC, EDTA, ionic silver. Hydrofiber technology within the dressing was helpful to wick away excess moisture and create an optimal environment for healing.

This wound was cumbersome. The patient, as his job required him to drive approximately 4 hours a day, location of the wound, and the driving requirement for his job, made it difficult for him to offload to ensure adequate blood flow and relieve pain and discomfort associated while sitting. Utilizing an offloading cushion while seated was helpful in decreasing his pain level and promoting healing. In addition, he was able to cut his nicotine consumption in half.

With the combination of lifestyle modification, offloading, and wound hygiene, he was able to heal his wound in just under 3 months and return to activities of daily living without any limitations.

Thank you.