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How to treat complicated wounds using Enluxtra dressings

4/17/2017

11 Comments

 
​We are often asked how to best apply Enluxtra dressing on wounds with such complications as cavities, tunnels (sinus tract), undermining, as well as fistulae.
Our Clinical Director Vicki Fischenich offers an expert advice.

(New to Enluxtra?  C​lick for FREE SAMPLES .)

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​Causes and prevention
Common cause of wound tunneling is infection of the underlying tissues. Infections could be of cutaneous origin or from deeper structures, such as bone in cases of osteomyelitis. Undermining, on the other hand, is usually the result of shear force when the patient is being moved or transferred, or sliding in resting position.
 
Treating the causes of these types of complications should be one of the first priorities: treating infection, offloading, exercising careful patient handling. It’s important to properly lift the patient with an existing wound rather than use dragging or pulling motions to avoid shear forces when transferring or repositioning them. Follow up with offloading the wound site as much as possible for faster healing.

​Treating complicated wounds
 
Here’s an example of a typical wound with undermining. Enluxtra dressing has been used to remove the black eschar scab and now the challenge is applying Enluxtra on this wound so slough continues to come off and the wound flattens out and heals.
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Below is the strategy suggested by our clinicians:
1. FILL THE WOUND WITH A PROPER PACKING MATERIAL

The purpose of filling a cavity, tunnel, sinus tract, etc. is to transfer exudate and slough away from the wound into Enluxtra dressing (where it will be reliably locked in) and it is VERY important to avoid dead space (voids) that may create further wound complications: seromas, or the upper part of wound closing on the surface and leaving an open space underneath. 
​ 
One of the critical considerations is selecting a product that retains its shape even when moist so it can stay in contact with the undersurface of Enluxtra dressing.  

Any product selected as a filler material must not shrink or decrease in size in the moist wound environment that may cause it to retract back from Enluxtra dressing. This situation often leads to maceration, foul odor; stalling of wound progress, wound decline.

Any filler material made of cellulose fiber (such as an alginate or Aquacel Ag or honey alginate) SHOULD BE AVOIDED.


We suggest that the caregiver fill the undermining spaces, tunnels or cavities with regular or AMD gauze using a Q-tip or a similar tool. It is important not to overstuff these spaces, just lightly place the gauze so it reaches the farthest points.

​2. CREATE EXTRA WICKING SURFACE 

Bring the end piece of gauze out and spread it across the periwound to create as much surface area that will touch the undersurface of Enluxtra dressing. This will aid in wicking even more exudate away from the wound (including its undermining parts) and transferring it into the Enluxtra dressing. The gauze spread across the periwound must be covered completely by Enluxtra with a 1” overlap onto the healthy skin.  Be sure that the removal of the dressing is done before drainage reaches the dressing edge.
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​3. ENSURE FULL CONTACT

Apply Enluxtra dressing and ensure that its undersurface is in FULL CONTACT with the packing material and with any areas of the wound that are not covered with gauze, especially sloughy parts. This will expedite the removal of non-vital tissue from the wound.


4. CHANGE THE DRESSING MORE OFTEN INITIALLY

Change Enluxtra dressing and wound filler every 2-3 days until the wound is clear of slough and non-vital tissue. Then gradually increase the time between  changes to up to 5-7 days, depending on the exudate level.
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5. DO NOT FORGET ABOUT PROPER NUTRITION
​

Another important thing to keep in mind is making sure the patient’s nutrition is adequate. Wounds like this consume a lot of calories, therefore the patient’s caloric requirements may be higher.

Below you can see Enluxtra dressing application in a recent case of deep tissue injury that progressed to unstageable wound with black necrotic tissue and then to an open wound with undermining (now completely healed!):
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REVIEW THE SUMMARY OF THE CORRECT APPLICATION TECHNIQUES IN THE SHORT VIDEO BELOW:
Tell us about your experience with Enluxtra! Are you treating a challenging wound? Do you need some advice? Our help line is open: call 888-519-2297 and use extension 7 for clinical support.
To self-educate, check out our mini-tutorials, attend a live clinical webinar, take a basic application mini-course, or, if you’re extra-ambitious, get certified!


If you are new to ENLUXTRA, do not forget to order professional FREE SAMPLES!

Read other posts in our blog.
11 Comments
Paula
6/1/2017 11:25:23 am

What is the active ingredient in this product?

Reply
Enluxtra Team
6/1/2017 11:40:27 am

Enluxtra is a patented superabsorbent multi-layer polymer structure with embedded hydrogel. The dressing utilises patented smart polymers for sensing the underlying tissue conditions and adapting local functions accordingly. The structure senses hydration level of the underlying tissue and responds to deviations from the optimal level.
Enluxtra is hypoallergenic, latex free, bio-inert, contains NO active medications or harsh antimicrobials. The mechanism of action is explained here:
http://www.enluxtrawoundcare.com/what-is-self-adaptive-dressing.html

Reply
Richie Souza link
6/25/2017 07:41:21 am

Wondering how I can get some of this,though my wound is not c
Deep it may help, as long as I'm not Allergic to it

Reply
Enluxtra Team
6/26/2017 04:36:23 pm

Richie,
You may ask your doctor to prescribe Enluxtra for you. The dressing is covered under the Medicare Part B, as well as many private insurance plans.
Or you may buy it OTC (no prescription) online (Amazon, etc)

Reply
Ríchie link
7/7/2017 08:00:42 am

Dr. Has To Order.... I Read About free samples....

Enluxtra Team
7/7/2017 01:52:03 pm

Richie, free samples are available to medical professionals only. Your doctor or nurse may order free samples for you to try. They have to feel a form here: http://www.enluxtrawoundcare.com/free-samples.html

Reply
Linda Jones
6/30/2017 09:33:46 am

My husband had osteomyelitis 40 Yrs ago and last year developed a fistula which enlarged with tunneling, undermining, eschatology, etc. Have been using Vashe' moistened Bulkee dressings with 4x4 and ABD dressings! Wound is on right hip measuring 21.4x17.4x2.8.

Reply
Carolyn link
9/20/2017 01:00:23 pm

Hello, I have a Stage 4, Coccyx wound that has not healed for over 798 days. It was almost ready to heal measuring 0.2 x 0.2 x 1.0 cm's. It has not declined and measures 0.5 x 0.5 x 2.0 cms. Currently being packed with Mesalts as primary dressing and Mepilex foam dressing Q day. Resident incontinent B& B. I do not know if this product will do the trick d/t the size. Thoughts?

Reply
Enluxtra Team
9/20/2017 04:08:24 pm

Carolyn,

Enluxtra 4x4 can be reduced in size by trimming to fit the area. Trim minimally, the more area around skin is covered by Enluxtra, the better is the wound/periwound/skin protection. if you would like you may use just moisten gauze for packing, and please follow the recommendations for deeper wounds (deep wound application), you may find the tutorial here:
http://www.enluxtrawoundcare.com/mini-tutorials.html

Use Tegaderm or Opsite to seal all the dressing edges to keep urine and stool out. Of course with any dressing in the area where incontinence is happening cross your fingers and hope that it does not get in the dressing edges. You may use skin prep or ostomy spray for adding tackiness to the tegaderm or opsite to secure better and hopefully longer wear. Please do NOT use skin prep or other creams/ointments under Enluxtra.

Reply
Simon Picken link
1/8/2020 02:15:50 am

Thanks a lot for explaining it very clearly with proper pictures. Now I know how to handle complicated wounds through your blog. I will use enluxtra dressings now!

Reply
Vivian Black link
2/19/2020 04:52:42 pm

You made a great point about making sure to ensure full contact so that the wound is covered with gauze. My husband and I are looking for a wound care service that can help us with the cut he got while we were camping. We will keep these tips in mind for the future after we search for a professional.

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