Authors (including presenting author) :
Kwok WY(1), Ho CW(1), Lau KY Kara(1), Tang CN(1)
Affiliation :
(1)Department of Surgery, Pamela Youde Nethersole Eastern Hospital
Introduction :
Undetected foreign body in wound may cause prolonged healing and unhealed wound. The blind surgical wound exploration to look for the foreign bodies may lead to an enlarged painful traumatic wound. This is a first local patient case report of the application of ultrasonography (USG) by nurse specialist aids to detect a foreign body in surgical wound.
Objectives :
Promote a diagnostic tools and therapeutic interventions in advanced wound nursing
Methodology :
Male, 76 years-old, presented as an unhealed surgical wound over 16 weeks. It looked as a prematurely healed sinus, complicated with a pin-hole 2mm opening and leaking amount of turbid wound fluid. The affected wound is highly erythema and painful. Despite the patient had been put on a repeated courses of oral antibiotics, microbiology tests and antimicrobial dressings, the wound was static in nature and size. For the pin-hole wound causing the failed inaccessible assessment. The USG (GE-Venue 40) and a 12-MHz linear probe was applied in wound investigation. During the wound USG examination, the image showed a two linear sharp hyper-echoic images which highly representing the presence of a radiolucent foreign bodies at the deep subcutaneous level. At the same time, thickened epidermal layer and collection was indicated by the cobblestone-like image. The wound could be highly represented a chronic inflammatory change with collections plus foreign bodies in wound. We proceed to USG guided exploration; foreign body removal and wound drainage under local anesthesia. Two detached pieces of surgical Polydioxanone Suture (PDS) in the deep subcutaneous plane were removed.
Result & Outcome :
After the USG guided wound exploration; foreign body removal and drainage, the pin-hole wound presented as a deep, large infected sinus and required dressing. After 2 weeks, the wound healed as a scar. Repeat USG showed the previous noted hyper-echoic images disappear and no cobblestone-like image was revealed. The tissue plane appeared well-structured and normal. Clinically, the first application of bedside USG by wound nurse specialist is challenging and advancing. It allows a non-invasive detailed assessment in wound from epidermal layer and down to deep muscle plane. The USG is highly operator dependent; despite it is the point of care in advanced wound nursing. Clinical mentorship is recommended to wound nurse in near future.
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