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 Table of Contents  
CASE REPORT
Year : 2020  |  Volume : 40  |  Issue : 1  |  Page : 62-65

Treatment of a wide wound area with extensive necrosis by modern dressing in a 1-month-old infant


1 Department of Nursing, School of Nursing and Midwifery, Qom University of Medical Sciences, Qom, Iran
2 Department of Epidemiology and Biostatistics, Neurology and Neuroscience Research Center, Qom University of Medical Sciences, Qom, Iran
3 Department of Nursing, School of Nursing and Midwifery, Artesh University of Medical Sciences, Tehran, Iran

Date of Submission07-Aug-2019
Date of Acceptance09-Oct-2019
Date of Web Publication6-Jan-2020

Correspondence Address:
Abolfazl Mohammadbeigi
Department of Epidemiology and Biostatistics, Neuroscience Research Center, Qom University of Medical Sciences, Qom, 3715614566
Iran
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/ejdv.ejdv_42_19

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  Abstract 


The current report aimed to introduce the history of wound treatment in a 1-month-old infant that was taken care by modern dressing with Aquasel tender wet plus and Colactive R plus collagen. The patient was admitted to the hospital with seizure, but after complete physical examination, it was revealed that her left thigh had experienced burning, and an extensive necrosis had occurred at the child’s skin. Injury debridement was conducted owing to vastness of the area of injury, and according to consultation with the children plastic surgeon, skin graft of patient was recommended. However, modern dressing with Aquasel tender wet plus and Colactive R plus collagen was used for treatment besides the combination dressing of Aquasel Ag+, foam Aquasel, and colactive collagen. Finally, the patient was treated with modern dressing and healed completely after 45 days.

Keywords: Aquasel Ag, infant, modern dressing, tender wet plus, wound treatment, wound


How to cite this article:
Ahmadli R, Mohammadbeigi A, Farshadpour N. Treatment of a wide wound area with extensive necrosis by modern dressing in a 1-month-old infant. Egypt J Dermatol Venerol 2020;40:62-5

How to cite this URL:
Ahmadli R, Mohammadbeigi A, Farshadpour N. Treatment of a wide wound area with extensive necrosis by modern dressing in a 1-month-old infant. Egypt J Dermatol Venerol [serial online] 2020 [cited 2020 Apr 9];40:62-5. Available from: http://www.ejdv.eg.net/text.asp?2020/40/1/62/275186




  Introduction Top


Wound is a scratch, tear, or perforation of the skin surface that is created by physical, chemical, mechanical, or thermal injuries [1]. According to the healing process, wounds are divided to chronic and acute wound categories. Acute wounds are caused by an injury, and the treatment duration is 8–12 weeks. Chronic wounds are scars caused by certain diseases such as diabetes, tumors, and difficult physiological infections [1],[2]. Improvements of chronic wounds can take more than 12 weeks, and return of these ulcers is unusual [1].

Inflammation, proliferation, and maturation are wound healing stages [3],[4]. Recently, modern dressings have been designed by modern technology and knowledge after recent development in wound healing. The modern dressing creates a moist environment for healing and has the most properties of ideal dressing [5],[6]. This method is an accepted care among key leaders of wound nursing and is superior to dry dressing, including foams, hydrogels, hydrocolloids, tender wet plus, and Colactive [1],[5].

Case history

The patient was a 1-month-old girl infant who was referred to the children hospital owing to the seizure. The informed consent was taken from the parents of patients and who were aware that the identical characteristics of their baby did not publish. The initial investigation and full physical examination revealed that the patient’s skin has been damaged owing to accident and led to skin necrosis in the left thigh. After the initial care, the patient was referred to the operating room for possible debridement. A surgeon removed the dead muscle tissue during the operation ([Figure 1]a). The leg muscle was affected extensively with necrosis, and plastic surgical consultation was done for treatment. According to reconstructive surgeon, owing to osteomyelitis, skin graft was recommended, and the patient was referred to Tehran, capital of Iran.
Figure 1 Immediately after the surgeon’s debride (a), after third meeting after using the tender wet plus (b), and after cleansing of necrosis tissue after using tender wet plus (c).

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Owing to some ethical and economical consideration, the patient was treated with modern dressing. For primary dressing, first the infant leg was cleaned by water and baby shampoo and then was washed by Nano-Nivasha spray and normal saline serum. Then, for complete cleaning of necrotic tissue, the tender wet plus 72 h was used for dressing ([Figure 1]b and c). After washing the wound in each dressing process, the edges of wound were supported by protective welland cream to prevent wound expansion. ([Figure 2]a). For debride and cleaning of the necrotic tissue, Dodrem gel was laid on necrotic areas, and the thin secondary dressing by Aquasel Ag+ and Dodrem was conducted ([Figure 2]b). From seventh to tenth session, dressing was conducted with Aquasel Ag+, foam Aquasel, and Dodrem gel, and from 10–15 sessions, combination dressing of Aquasel Ag+, foam Aquasel, and colactive collagen was applied ([Figure 2]c). The full improvement of wound was conducted after 45 days ([Figure 3]a and b).
Figure 2 Use of protective welland cream around the wound (a), use of Aquasel Ag+ in wound dressing (b), and use of Aquasel foam in wound dressing (c).

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Figure 3 Restoration of the skin after using colactive collagen (a) and after 40 days (b).

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  Discussion Top


Wound improves more faster in a physiologically moist area, and maintaining a moist environment in wound could facilitate the healing process [7],[8]. In the moist environment, the speed of epithelialization and wound closure doubles, the production of collagen increases, and the formation of granulation tissue speeds up [5]. Modern dressing reduces pain even during change of dressing. Moreover, wound infection prevalence is higher in ulcers that are covered by gauze than modern dressing. The modern dressing acts against bacteria by creating a moist environment and maintaining a slightly acidic pH. In addition, it increases phagocytes activity that deals with bacteria [9].

Generally, the wound dressings are divided into two types: traditional and modern. In traditional method, wounds were dressed daily and antibacterial ointment was used [2],[5]. In most cases, despite antibacterial ointment use, wound can be infected and cause problems. Moreover, removal of the conventional gas from wound causes trauma and debride of the newly created skin epidermal, causing a delay in healing process [5].

In the past, treatment of acute cutaneous wound included cleaning of wound by hydrogen peroxide and povidone-iodine. These substances decrease the proliferation and migration of fibroblasts in a dose-dependent manner. It has been shown that dressing type plays an effective role in healing of wound. Wound healing in a moist physiological environment is faster, and maintaining a moist environment in wound facilitates the healing process [2],[7],[8].Wound healing by wet dressings could maintain and control the ulcer humidity, besides other conditions provide an appropriate environment for healing [10].


  Conclusion Top


Type of dressing and the used substances in dressing have an important role in wound healing. However, modern dressing with tender wet plus and Colactive could be an effective care for wounds that are extensive. Moreover, the combination dressing of Aquasel Ag+, foam Aquasel, and colactive collagen increases the speed of skin epithelium growth, and the moist environment of modern dressing causes pain control, decreases pain severity, and leads to infection prevention.

Acknowledgements

The authors are very grateful for all coworkers who cooperate in the study.

R.A. contributed toward the conception or design of the work, interpretation of data for the work, and final approval of this paper; A.M. contributed toward the conception, design of the work, analysis, interpretation of data, and final approval of this paper; and N.F. contributed toward the acquisition and analysis of data for the work and drafting of this paper.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Zahedi P, Rezaeian I, Ranaei Siadat SO, Jafari SH, Supaphol P. A review on wound dressings with an emphasis on electrospun nanofibrous polymeric bandages. Polym Adv Technol 2010; 21:77–95.  Back to cited text no. 1
    
2.
Gurjala AN, Geringer MR, Seth AK, Hong SJ, Smeltzer MS, Galiano RD et al. Development of a novel, highly quantitative in vivo model for the study of biofilm impaired cutaneous wound healing. Wound Repair Regen 2011; 19:400–410.  Back to cited text no. 2
    
3.
Alexiadou K, Doupis J. Management of diabetic foot ulcers. Diabetes Ther 2012; 3:4.  Back to cited text no. 3
    
4.
Wodash AJ. Wet-to-dry dressings do not provide moist wound healing. J Am Coll Clin Wound Spec 2013; 4:63–66. doi: 10.1016/j.jccw.2013.08.001.  Back to cited text no. 4
    
5.
Ghaderi R, Afshar M. Novel advancements in wound healing. J Birjand Univ Med Sci 2014; 21:1–19  Back to cited text no. 5
    
6.
Khemariya R, Khemariya P. Comparative evaluation of efficacy of pure collagen type I based modern dressing with conventional dressing in the treatment of burn and diabetic foot ulcer. Int J Curr Res Med Sci 2016; 2:1–10.  Back to cited text no. 6
    
7.
Atiyeh B, Al-Amm C, El-Musa K, Sawwaf A, Dham R. The effect of moist and moist exposed dressings on healing and barrier function restoration of partial thickness wounds. Eur J Plast Surg 2003; 26:5–11.  Back to cited text no. 7
    
8.
Bolton L. Operational definition of moist wound healing. J Wound Ostomy Continence Nurs 2007; 34:23–29.  Back to cited text no. 8
    
9.
Seyedalshohadaee M, Rafii F, Hoseini A, Karimi H. Comparative study of the effect of dry and moist dressing on burn wound. Iran J Nurs 2012; 24:20–27.  Back to cited text no. 9
    
10.
Braiman-Wiksman L, Solomonik I, Spira R, Tennenbaum T. Novel insights into wound healing sequence of events. Toxicol Pathol 2007; 35:767–779.  Back to cited text no. 10
    


    Figures

  [Figure 1], [Figure 2], [Figure 3]



 

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