Authors (including presenting author) :
Yeung CY(1), Chong HM(1)
Affiliation :
(1) Wound Care Team, Tuen Mun Hospital
Introduction :
A 72-year-old woman experienced an open reduction and fixation of the left patella 23 years ago. She recently discovered a wound on the old scar with purulent discharge. She was referred to our specialty wound nurse clinic after several conservative treatments with different wound dressing materials in a year.
Objectives :
The objective of this case study was to employ ultrasound-guided techniques for the precise identification and removal of foreign bodies hindering wound healing in the patient's non-healing wound.
Methodology :
A small tunnel with slough and purulent discharge was identified on her left patella. Considering the fair results of the application of multiple wound dressing materials, the possibility of foreign bodies was suspected. A trained wound care nurse with 6-year experience of using ultrasound sonography (USG) revealed several suture loops and knots behind the tunnel wound and identified suture residue at the tip of the tunnel with the aid of a linear transducer. The suture residue was removed under USG guidance, followed by treatment with a Dialkylcarbamoyl chloride (DACC)-coated wound contact layer. DACC wound contact layer provided a physical bacteria binding effect, with its non-dissolvable, non-releasing properties and not-easy-to-break properties, it was considered a suitable wound packing material for this tunnel wound.
Result & Outcome :
Following the removal of the stitch residue and the application of the DACC wound dressing, the wound on the left patella exhibited substantial healing, leading to a well-functioning knee within two weeks. No recurrence was reported. The successful outcome underscores the critical significance of accurately identifying the etiology of wounds and addressing relevant contributing factors. Foreign bodies, particularly suture materials, can impede the healing process by potentially provoking delayed inflammatory responses.
Given the operator-dependent nature of ultrasound quality and the inherent subjectivity in interpretation, the presence of a skilled wound care nurse proficient in utilizing ultrasound imaging is paramount during such procedures. This case highlights the efficacy of ultrasound-guided techniques in detecting and managing foreign bodies within wounds, emphasizing the necessity for trained personnel to optimize wound care interventions effectively.
