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ESCHAR: NATURE'S BAND-AID OR A TIMEBOMB?

7/14/2015

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We have just received a report of an impressive case on eschar removal with the help of Enluxtra wound dressings. 

Black eschar is seen as a somewhat controversial topic in the clinical community. The general existing guideline advises to keep the "stable" eschar in place and let it protect the wound unless there are factors that prompt more aggressive treatment approaches.

We thought it would be interesting for our current and future users to see the results of Enluxtra applications that gently, non-surgically and painlessly removed black eschar from an unstageable heel wound.

Here's the story as told by Marilen Cabrera, the RN who treated the patient:
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"I was seeing one of my patients, a 77-year-old woman, for treatment of the wound on her heel. She was hospitalized for cerebral hemorrhage and later discharged to home where she lives alone. Her wound started as a deep tissue injury and progressed to becoming a large unstageable pressure ulcer covered with black eschar. 

My patient has been suffering from numerous health issues for quite a while and has a history of diabetes and other serious conditions such as stroke, hypertension, osteoarthritis, and congestive heart failure. She was on insulin twice daily but not very consistent with her medications because of forgetfulness. Being chair-bound due to weakness, my patient also had bilateral leg edema with 2+ pitting edema. Her legs had poor circulation, which was not conducive to fast healing of her wound.
We started with Betadine treatment 3 times per week from the onset of eschar in February 2015 in order to stabilize it, but this led us nowhere, even with existing pressure relief. After 3 months of this, we started using Enluxtra and my patient's fortunes have certainly turned for the better.

The first 3 Enluxtra applications included hydrogel to help soften eschar that was too dry. Once its edges started loosening, we still had no option to debride the wound due to various reasons, so we just continued on with Enluxtra.


We have used a total of 5 Enluxtra dressings over a period of 3 weeks and achieved complete removal of the eschar with nice granulation starting on the wound."
Marilen is a Registered Nurse who graduated from City Colleges of Chicago in 2005. She has 3 years of hospital and 10 years of home health experience. She is currently working with multiple home health agencies in the Chicago area (Home Life Health Care, Metropolitan Home Health Care, Life Options and Horizon Home Health Care).
May 04, 2015: wound on Betadine paint order, prior to starting Enluxtra.
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May 29, 2015: dressing #1 removed after 1 week. 
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June 03, 2015: dressing #2 removed.
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June 05, 2015: dressing #3 was changed prior to 7th day due to urine leaking down the leg causing Enluxtra to absorb the liquid; this  called for a dressing change to prevent maceration.
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June 10, 2015: dressing #4 removed. Eschar scab starts coming off.
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June 15, 2015: dressing #5 removed.
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June 18, 2015: eschar is completely off the heel.
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Update and good news!

​We have just received the finalized photos of this patient's wound. In July, 2015 the patient had been temporarily transferred out of Home Health care into a nursing home. Enluxtra treatment had been stopped at that point in time. However, later that year, the patient was back in Marilen’s care and treated with Enluxtra again. The wound completely healed before the year’s end.
​Here’s the image showing the progression from unstageable black eschar to a closed wound.
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Heel wounds are notoriously difficult for dressing application. We recommend that you cut slits in the dressing to have it wrap the heel completely. This will ensure the full contact of the dressing surface with the wound —an essential condition for Enluxtra to work (watch our Basic Rules video for more information).  Check out the pictures below for a technique Marilen used to apply Enluxtra on this wound.
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Happy healing!

​See other posts in the Enluxtra Blog
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