Successful Management Of Elderly Burns Using Pressurized Pulse Irrigation In Long-term Care
Patrick V. Marasco, MD1, Keri VIckery, RN2, Jeanine Maguire, MPT, CWS3.
1Plastic Surgery Center, North Andover, MA, USA, 2Genesis Health Care, Isle of Shoals Rehabilitaiton, AL, USA, 3Genesis Health Care, Kennett Square, PA, USA.
Background: Elderly burn patients in long-term care suffer increased morbidity and mortality due to age-associated complications after burn injury. Patients are susceptible to slower healing and wound infection due to age-associated immune dysfunction, thinning skin and underlying diseases such as cardio-pulmonary dysfunction and diabetes. Pressurized pulse irrigation (PPI) is a form of hydromechanical debridement applied in operating rooms for surgical and traumatic wounds. Closed Pulse Irrigation (CPI*) utilizes a "closed" delivery system allowing point-of-care (POC) treatments in long-term care using an omnidirectional irrigation containment device. Daily CPI* treatment removes planktonic and biofilm bacteria, tissue necrosis and foreign bodies from wound surfaces thereby promoting rapid granulation/epithelialization. Purpose: We describe 4 elderly burn wound patients with 10 separate 2 ͦ /3 ͦ difficult non-healing burn wounds, who were successfully healed without complication after hydromechanical burn wound debridement. Methods: CPI* hydromechanical debridement was implemented by trained Nursing/Rehabilitation Interdisciplinary Wound Teams in long-term settings. All burn wounds were treated using a standardized CPI*- POC delivery system with 3 Liters of 0.9 % Normal Saline (85 ͦF) at 8 - 15 psi pressure. Daily dressings included Silver Sulfadiazine 1% or Hydrogel. Results: CPI* hydromechanical debridement was well tolerated and achieved complete secondary healing without complications, re-admission or surgical excision. Conclusions: The CPI* system provides a standardized, effective, low cost solution for treatment of non-healing elderly burn wounds. CPI* hydromechanical debridement is a burn wound innovation that appears to improve elderly burn wound long-term outcomes and should be further investigated.
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