Resolution of Paraplegic Pressure Ulcer within a Challenging Home Setting

BACKGROUND: Discharge planning was complex for a new paraplegic to an unsupervised home setting with high-school-educated, non-medical caregivers. The patient had a history of wound infection, limited income and education, and no access to handicap equipment in his rural mobile home setting. OBJECTIVE: Medical managementʹs goals were to maintain an infection-free wound while promoting independence to the newly diagnosed paraplegic. METHODS: After 6 weeks in acute care, the patient was ready for discharge. The sacral wound upon discharge measured 3cm x 2cm x 1cm with undermining at 1 oʹclock with visible tendon. The family was instructed to provide a simple dressing change, BID, with moistened antimicrobial gauze while incorporating pressure reduction interventions. A Wound Ostomy Continence nursing clinic provided weekly monitoring. RESULTS: The wound resolved in 6 months. Six weeks after discharge, the wound bed, including the tendon at the base of the wound, was covered with granulation tissue. During the following 5 weeks, undermining resolved and the wound decreased in size to 2 cm. Five weeks later, wound depth decreased to 0.5 cm with the wound granulating, contracting, and healing. There was no recurrence of infection throughout the entire treatment. CONCLUSION: Despite the challenges presented by this rural home setting with limited resources, this 6-month-old wound completely healed without further infectious complications. This was achieved through simple wet-to-dry dressing changes BID using antimicrobial gauze. Furthermore, weekly trips to the outpatient wound clinic not only allowed for wound assessments, but also simultaneously enhanced the patientʹs independence.