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ny caregiver who has been practicing for a significant amount of time knows that there are some contours of the human form that present real difficulties in the management of wounds, whether chronic or acute. Dressing wounds on heels, sacral areas, stumps, feet, and hands is a task that can be both challenging and frustrating. Finding a dressing that will remain in place for any length of time yet be gentle to surrounding skin is a significant clinical problem, specifically in these cases.
       In addition to the anatomic challenges wound care can present, there are other concerns that guide topical decisions. The present financial healthcare atmosphere dictates that clinicians make cost-effective wound management choices. We also face the painful reality of a nursing shortage. With these difficulties compounding the challenges of treating patients with the above-mentioned wound types, it is clear that an ideal solution to dressing choice would be one that is effective, is available in custom shapes, and minimizes both treatment costs and caregiver labor.

Wound Challenges and Solutions
       Sacral ulcer. One challenging case was that of a 79-year-old woman with diabetes who presented July 19, 2002, with a chronic sacral wound that was subject to recurrent infections caused by fecal incontinence. For any sacral ulcer, there is concern about whether the dressing maintains a stationary seal. Often, if not designed specifically for the sacral area, dressings used in that area have a tendency to bunch up and adhere poorly, resulting in leakage and possible damage to delicate, surrounding skin. The solution to this type of problem is either to have a caregiver alter a nonspecific dressing or to use a dressing designed specifically for the sacral area.
       This patient had previously been treated with Kaltostat® dressing as the primary dressing and gauze as the secondary cover dressing. This treatment protocol had the disadvantage of requiring twice-daily dressing changes. Starting in October, the treatment protocol was changed to utilize Versiva® dressing as the secondary cover instead of gauze. Dressing changes decreased from twice a day to once every three to five days—a change the patient appreciated. The patient was discharged in January of 2003 because the wound had improved significantly.
       Heel ulcer. A 77-year-old man with type 1 diabetes presented with bilateral foot and heel ulcers. He had undergone two bypass surgeries and had lost the toes on his right foot. Poor circulation in his left leg as well as methicillin-resistant Staphylococcus aureus (MRSA) complicated treatment of his left foot. One of the challenges of managing heel wounds is finding a conformable and flexible dressing for this highly mobile location. This will reduce the chance of the dressing coming off of the wound.
       AQUACEL® Ag silver dressing was used to manage the heavy bioburden as well as excess exudate, and Versiva dressing was used to cover because of its ability to conform to the heel shape. The right foot was also managed with Versiva dressing. After 11 months of treatment, both the left and right foot wounds were healed.
       Stump wound. In January of 2003, a 61-year-old woman presented with failed bypass surgery and below-the-knee amputation of the left leg. An ulcer on the stump had not healed for two months, and the exposed nerve endings were causing the patient tremendous pain. As with heels, standard dressings are problematic when treating stump wounds because of conformability issues.
       Previously, the patient had been treated with compression bandages and gauze, which required frequent, painful changes. The wound was also not healing. The patient was switched to AQUACEL Ag dressing covered with Versiva dressing for heels. The heel dressing was ideal for managing the stump, since it is designed for convex contours, and it adheres firmly yet gently to the site. Dressing changes decreased from twice daily to once every three to five days. By the middle of February, the wound was nearly healed.
       Thumb. A woodworking accident sent a 77-year-old man to the emergency room with a full-thickness saw wound on November 11, 2002. He was started immediately on AQUACEL Ag dressing due to the risk of infection from the dirty saw blade. The challenge in managing this acute wound was the fact that the patient, an avid woodworker, was anxious to get back to work while still recovering from his injury. That meant the wound had to be kept clean, and the dressing had to stay in place.
       To protect the wound and ensure the AQUACEL Ag dressing stayed in place, Versiva was chosen as the secondary dressing because of its conformability and cushioning characteristics as well as its barrier properties. It was placed over the thumb and pinched on the sides to create a secure seal around the wound and the AQUACEL Ag dressing. The wound reepithelialized by December 10, 2002.

About Versiva
       Versiva is a new foam composite dressing by ConvaTec, a Bristol-Myers Squibb Company (Princeton, New Jersey). It comes in a variety of sizes and shapes, including specifically designed dressings for the difficult-to-dress heel, stump, and sacral areas. The Hydrofiber® technology within the dressing helps manage moderate to heavy wound exudate. Easy-to-apply Versiva dressing also features a gentle, easily removable adhesive, which makes it a perfect choice for fragile skin. The dressing is also waterproof, permitting patients to shower or bathe with it in place. It cushions and conforms, allowing patients freedom of movement. Many patients attribute their pain reduction to this new dressing, because maximum recommended seven-day dressing wear times mean fewer dressing changes. This also leads to less caregiver time spent on dressing management.
       Versiva can be used as both a primary and secondary dressing, depending on the amount of drainage. When there is excessive exudate, AQUACEL® dressing can be used as the primary dressing, thus enhancing Versiva’s wear time. Under the supervision of a healthcare professional, for infected wounds or those at risk, AQUACEL Ag dressing can be used with Versiva dressing where occlusion is not contraindicated. This protocol reduces the number of dressing changes, thus reducing overall costs as well.
       While no dressing is appropriate for every wound, these cases showed Versiva dressing to be an excellent option for anatomically challenging, moderately to heavily draining wounds. The cases presented illustrate the success possible with this product. For patients presenting with fragile skin and hard-to-dress wounds, Versiva dressing can be an optimal choice.
       Kaltostat, Versiva, AQUACEL, and Hydrofiber are registered trademarks of ER Squibb & Sons, LLC.