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Hematoma badly infected by Escherichia coli

Author(s): Santacroce Morena and De Mola Angela

Published: 8 October, 2021

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Case Study

Dr. Morena Santacroce, medical doctor specialist in Plastic Surgery at the O.R.L. operating unit- Hospital of Crema, Italy.
Angela De Mola, nurse specialist in Wound care and Stomatherapy at the operating unit of internal
medicine in collaboration with the wound care- diabetic foot center – Hospital of Crema, Italy.

INTRODUCTION
Patient: 79-year-old woman, weight 50 kg, hospitalized in April 2018 with a septic shock due to acute enteritis caused by Clostridium difficile, which resulted in respiratory insufficiency and anemia. Outbreak of COPD, atrial fibrillation, arterial hypertension with organ damage, myelofibrosis, UTI caused by sporadic Escherichia coli. Hematoma badly infected by Escherichia coli (after the execution of pus swab) in the left posterior thigh. ABG test and formation of inflammatory fasciitis of the thigh on the ulcer colonized with MRSA and Proteus mirabilis. Clinical picture of acute renal failure (ARF) on chronic renal failure.
Wound: On 18/05 left thigh: diameter 2 x 3 cm, undermined in the whole area of 5 cm at 11:00 (thus directed towards the genital area) and of 6 cm at 3:00. Wound bed well-cleansed. Blood serum liquid with controlled pain. A soft tissue ultrasound scan was carried out on 29/05 furnishing proof of discrete abscess reduction.
Medical reasoning: We have opted for SNAP system because it is able to contract the wound edges
reducing its size, stimulate angiogenesis, increase the formation of granulation tissue and reduce the edema. Its application is simple and fast. The SNAP System is portable and it permits patient to move given that it is worn under clothing. Its silent design minimizes sleep interruptions.

METHODS
Initial SNAP therapy: Start of SNAP therapy in the department of medicine on 13/06. Preparation of a sterile field and we proceed with the irrigation by using Prontosan with a 30 cc syringe by a 20 G plastic tube and we tampon with a TNT gauze by means of anatomical tweezers. Then we tampon with polyurethane foam well adapted to the wound bed, we apply the protective product on the perilesional skin and afterwards we also apply the polyurethane film on the wound sealing it with advance medicine (SNAP TM hydrocolloid).
Then we connect the SNAP TM therapy cartridge and remove the key of the cartridge. Finally, we apply  The SNAP on the thigh using the strap provided.

RESULTS
The SNAP treatment started on 13/06. The exudate volume was 150 cc of blood serum liquid. The SNAP was renewed in plastic surgery clinic on 15/06 and on 19/06. Snap replacement on 26th and 27/06 when a tampon of the wound colonized with MRSA was carried out with a successive wound isolation. Replacement of SNAP every 4 or 5 days. The wound diameter was 1 x 1 cm on 11/07, tunneling at 11.00, measuring 3 cm long. The exudate volume was 30 cc of blood serum liquid. Replacement of SNAP on 24/07 with the appearance of reduced fistula. Removal of SNAP on 31/07 and tamponade of the remaining cavity with silver ion medical treatment.

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Discharge

The patient entered the clinic on 27/08, the fistula had closed up so the patient had recovered.

DISCUSSION

Economic evaluation: According to the Hutton and Sheeham studies published in I. Wounds, the Snap could save substantial treatment costs and offer patients more mobility.

CONCLUSION
SNAP therapy system presents ease and practicality guaranteeing patients\’ rest since it is not noisy. Easily manageable even in less compliant patients. In our case the ulcer area responded very well to the application of SNAP .

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