Case Series/Study

(CS-014) A Unique Technique for Management of Challenging Surgical Wounds: Treatment of a Thoracic Wound Complication with a Transforming Powder Dressing (TPD)

Co-Author(s):

Tammy Jensen Lichtman, RN, BSN, CWON – Advent Health Orlando

Introduction: Traditional standard of care (SOC) management of surgical wounds involves conventional dressing applications or negative pressure wound therapy (NPWT) to accelerate wound healing.1 Current SOC, however, is limited in treating complex surgical wounds. NPWT can be painful and difficult to apply in certain anatomical locations.2 Conventional dressings require frequent applications and drain medical resources while increasing patient discomfort and exposure to wound contamination. Alternative treatment modalities must be considered to provide optimal patient care. We present a case study incorporating treatment with Transforming Powder Dressing (TPD) in a patient with a complicated thoracotomy related wound with a chest tube. Methods: A 34-year-old male with no significant prior medical history was admitted for COVID-19. Hospital course was complicated by pulmonary hemorrhage s/p right thoracotomy, and a subcutaneous hematoma evacuation requiring incision and drainage resulting in a nonhealing right thoracotomy wound. NPWT was utilized unsuccessfully (hard to get a proper seal) due to the presence of a nearby chest tube. 
Patient reported constant pain (VAS 5/10) at the wound site, worse with dressing changes. The clinical goal was to expedite wound healing so that he could be evaluated for a lung transplant, and to reduce overall pain and dressing changes. Results: NPWT was discontinued and TPD was initiated in conjunction with anti-microbial therapy to manage the wound. After application of TPD, the patient experienced immediate reduction in pain. Two weeks after TPD treatment was initiated, VAS pain levels were 0/10. Dressing change requirements were substantially reduced due to TPD’s extended wear time. Overall caregiver resource utilization due to the reduction in dressing change requirements was also achieved. At week 6, a significant reduction in wound size was observed. By week 11 post start of TPD, the wound was closed, and the patient was able to be evaluated for lung transplant. Discussion: Although chest tube insertions are used routinely to drain pleural collections, these invasive procedures are associated with high complication rates (20-40%), including surgical site infections and bleeding, that can occasionally be life threatening.3 Patient comfort and safety are the ultimate priorities in the care of patients with challenging surgical wounds. Alternative treatments must be considered due to the current limitations of SOC. 
 Based on the clinical observations and outcomes of this case study, we conclude that TPD presents a safe and effective modality for the treatment of challenging surgical wounds. Trademarked Items: References: 1. Harries, R. L., Bosanquet, D. C., & Harding, K. G. (2016). Wound bed preparation: TIME for an update. International wound journal, 13 Suppl 3(Suppl 3), 8–14.
2. Upton, D., & Andrews, A. (2015). Pain and trauma in negative pressure wound therapy: a review. International wound journal, 12(1), 100–105.
3. Hernandez MC, El Khatib M, Prokop L, Zielinski MD, Aho JM. Complications in tube thoracostomy: Systematic review and meta-analysis. J Trauma Acute Care Surg. 2018;85(2):410-416. doi:10.1097/TA.0000000000001840