(CS-142) Reduction in Wound Pain by Using a Polymeric Membrane Dressing on a Post Surgical Below the Knee Amputation

The primary goals of post-surgical amputation management include: prompt, uncomplicated wound healing, control of edema/postoperative pain, prevention of joint contractures, and rapid rehabilitation.¹ Wet-to-dry dressings are the current standard of care (SOC) for post operative wound care. Due to the psychological stress and physical pain associated with surgical wounds, pain due to dressing change and wound complications should be mitigated utilizing dressings which promote tissue proliferation as well as reducing painful dressing changes. One of the most difficult challenges for any wound care prescriber is to balance the potential benefits versus the potential risks of opioid prescribing.²

Methods: A 32-year-old male presenting in the emergency department with chief complaint of dizziness. Multiple skin lesions noted which were concerning for purpura or possible Kaposi sarcoma. Patient transferred to ICU and was in septic shock secondary to community acquired fulminant disseminated bacterial meningitis. Purpura fulminans (an extreme thrombotic subtype of disseminated intravascular coagulation (DIC)), complicated with extensive skin necrosis, infection, and dry/wet gangrene, resulting in bilateral below the knee amputation (BKA). Wet-to-dry dressing used to cover the fresh surgical tissue resulted in unnecessary pain during dressing changes. It was decided that a polymeric membrane dressing* (PMD) would be more suitable in reducing pain associated with daily dressings. PMDs help to focus inflammation into the primary injured tissue, reducing both wound and periwound edema and pain, while supporting healing.

Results: PMD dressing significantly reduced wound pain from prior 8 (0-10) pain scale, to 2 during dressing changes. There was a 75% reduction of opioid administration secondary to the use of the PMD. Because the standard of care (SOC) post-surgically for wound dressings have been wet-to-dry dressings, patients would benefit in using PMD in reducing pain associated with treatment and dressing changes.

Discussion: PMD was successfully used by our wound care team on post-surgical wounds. Because of the moist milieu presented by PMD, a noticeable tissue proliferation increase was apparent. Ease of replacement during dressing changes provided comfort/relief. Daily dressing changes with PMD reduced wound pain, reduced opioid use, increased patient satisfaction, and provided a viable treatment for post-surgical wounds.