Sound Evidence - October 2008 - (Page 60) A Topical treatment was initially silver antimicrobial gel; however, this was not well tolerated, so a broadspectrum antibiotic/hydrocortisone ointment compounded by the family’s pharmacist was used. The children’s heads were wrapped with roll gauze. Data were extracted from patient charts from February 2008 to August 2008. Data included number and duration of APWT treatments, wound bed characteristics, and wound dimensions. The effect of APWT was assessed by evaluating changes in wound bed characteristics and dimensions. Results From February 2008 to August 2008, the boy and girl each received 37 APWT treatments. After the boy and girl received five and three treatments, respectively, the scalp crusts were completely debrided, epithelial tissue was observed at the wound edges, and exudate volume decreased. Before the children’s first visit to the authors’ wound clinic, bacterial cultures were positive for Staphylococcus aureas and the wounds had purulent exudates. Following initiation of APWT, culture results were negative and clinical signs of infection had resolved. Substantial improvement for both children occurred during the first 5 weeks of consistent treatment at the clinic (see Figure 2a,b). However, the children missed many treatments due to surgeries, illnesses, and family issues, resulting in deterioration of their wounds (see Figure 3a,b). In August 2008, the wounds of both children were 70% granulated. The boy’s wounds were substantially improved compared to the girl who had more severe wounds. The boy’s wound decreased in size from 364 cm2 to 250 cm2 (31.3%); the girl’s wound decreased from 364 cm2 to 360 cm2 (1.1%). Treatment with APWT is ongoing. Both children continue to show signs of epithelial progression. During treatments, the children are easily distracted with small toys. Treatments were administered with one parent holding the child on his or her lap and protecting the child’s face from the mist with a washcloth. Considering their young age, the children cooperated well during treatments and did not appear to experience treatment-related pain. B Figure 2a,b. The twins (girl, a; boy, b) after five treatments with APWT (March 2008). Consistent weekly treatment with APWT resulted in rapid and complete debridement, epithelial progression, and elimination of infection. Treatment The authors selected APWT because other treatments had not provided long-term benefits and because APWT has the combined benefits of decreasing bioburden and promoting healing by stimulating fibroblasts. Initially, APWT was administered once weekly. In consideration of the family’s distance from the clinic, an APWT machine was obtained for their local pediatrician’s office, where treatments could be administered three times weekly, in addition to monthly evaluation at the authors’ clinic. Treatments were 3 to 10 minutes in duration. 60 OstomyWound Management
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