Case series of complex wounds treated with zinc-base hydrophilic paste.
Case 1: 57 yo male with necrotizing fasciitis requiring abscess drainage, debridement and fasciotomy. After 5 years and multiple treatments (NPWT, hydrofibers, foams, antimicrobial dressings, medical honey, collagen matrix, etc.) his wound remained unhealed. The patient was started on zinc-base hydrophilic paste and was almost healed after 48 weeks.
Case 2: 58 yo female with septic arthritis leading to septic shock, intubation and cardiac arrest. High doses of vasopressors caused necrosis of all ten toes and plantar aspect of bilateral feet. Surgical debridement was not initially possible. Autolytic debridement of the dry eschar was therefore done with hydrogel; however, it was not able to debride soft necrotic tissue. The patient was then switched to zinc-base hydrophilic paste which significantly improved the wounds. The patient then underwent bilateral transmetatarsal amputation (TMA) and calcanectomy to help in eventual wound closure. She was treated with NPWT to the calcanectomy site and zinc-base hydrophilic paste. Once the cancanectomy site had filled in, we switched back to zinc-base hydrophilic paste. After 66 weeks, her wounds are almost healed.
Case 3 and case 4: 73 and 81 yo males with Ear, Nose, Throat (ENT) cancers requiring surgical excision, reconstruction with free flap from forearm, and split thickness graft from the thigh. Split thickness skin grafts to wrists failed over tendon. Patients were started on zinc-base hydrophilic paste. One patient has healed (12 weeks) and one patient is almost healed (9 weeks).
Implications for practice: At my health center, we used to use zinc-base hydrophilic paste almost exclusively for the treatment of pressure injuries in the coccyx area. We started using it in cases as a “last resort” and found that it worked. We now use it as a first line treatment. It is easy and cost-efficient way to manage complex wounds.