A Clinical Minute: Don`t Give Up on That Wound — A Palliative Care Perspective

Ostomy Wound Management introduces a new occasional column that focuses on the many clinical indications of MEDIHONEY®. We invite you to share your feedback and professional experiences with this product in the Comments section that follows each article at www.o-wm.com.

When faced with challenging wounds in the palliative care patient, clinicians may feel there is little that can be done. Palliative care focuses on relieving and preventing suffering, as opposed to wound healing and closure. Wound management in palliative care involves comfort care goals such as stabilizing the wound, minimizing odor, and decreasing the frequency of dressing changes. Blending these comfort care goals with wound healing knowledge may empower clinicians not to give up.   MEDIHONEY® (Derma Sciences, Inc, Princeton, NJ) is a wound dressing we commonly use in this patient population to help reach these comfort care goals. The product impacts wound healing through two key mechanisms of action: 1) a low pH (3.2–4.5) helps modulate alkaline pH common in chronic wounds¹, and 2) high osmolarity increases wound bed fluid and promotes autolytic removal of nonviable tissue.^1-5 In addition, MEDIHONEY® has a pleasant smell patients appreciate.

The two cases presented here illustrate the use of MEDIHONEY® in the palliative population and the comfort care goals achieved.

Case 1. A 93-year-old man with respiratory failure and exacerbated congestive heart failure was on end-of-life care and had an unstageable pressure ulcer on his coccyx that initially presented as a Kennedy Terminal Ulcer (see Figure 1). We applied MEDIHONEY® calcium alginate dressing with a secondary foam dressing for added absorption and cushioning. This plan allowed us to initiate dressing changes two to three times per week versus everyday.

On day 18, slough was almost completely gone and healthy granulation tissue was noted from 3 to 9 o’clock (see Figure 2). The slight increase in wound size observed was expected due to the autolytic debridement of nonviable tissue. By day 30, despite the patient’s declining health, there continued to be signs of active granulation tissue development (see Figure 3). The patient died 1 week later, but by stabilizing the wound, reducing malodorous nonviable tissue, and decreasing the frequency of dressing changes, the comfort care goals for this patient were achieved.

Case 2. An 80-year-old woman with end-stage Parkinson’s disease, diabetes, and dementia had a rapidly declining pressure ulcer on her left trochanter with significant amount of slough, which appeared to be causing malodor (see Figure 4). The patient and family allowed us to use conservative sharp debridement to rapidly remove the nonviable, malodorous tissue and stabilize the wound, preventing further problems. The patient also received an alternating pressure mattress and nutritional support. Following debridement (see Figure 5), MEDIHONEY® calcium alginate and a waterproof composite dressing were applied. The dressings were changed two to three times per week.

The patient’s health continued to decline, but 5 days later there were signs of granulation tissue formation (see Figure 6). With the removal of nonviable tissue and subsequent malodor and a low dressing change frequency, our comfort care goals were achieved.

These palliative care cases show how clinicians can achieve comfort care goals that enable patient dignity and family support at the bedside. In short: Don’t give up on that wound!

To learn more about MEDIHONEY® for palliative wound care, visit the MEDIHONEY® Power Webinar series at www.dermasciences.com/elearning-portal/ for a 30- minute case review by Angel Sutton.

A Clinical Minute is made possible through the support of Derma Sciences, Inc, Princeton, NJ. The opinions and statements provided in A Clinical Minute are specific to the respective authors and not necessarily those of OWM or HMP Communications. This article was not subject to the Ostomy Wound Management peer-review process.