(CS-112) Self-Care of Full-Thickness Cape Buffalo Gore Wounds in Remote Village Without Complications or Grafting

Introduction: A 19-year-old man in rural Tanzania was gored by a Cape buffalo, resulting in painful, bilateral full-thickness thigh wounds with exposed muscle. Horn wounds are often fatal due to contamination/infection, especially with the poor follow-up and unsanitary conditions common in developing countries. The patient was hospitalized with surgical cleaning/debridement on the 1st and 5th day, Diclofenac for pain of 8/10, and twice daily wet-to-dry dressing changes. He was discharged to home of local preacher and care of community nurse on day 6. Right wound ~10x10cm with extensive undermining in multiple directions with slough/heavy drainage; left wound ~6x4cm with two areas of undermining.

Methods: Polymeric Membrane Dressings* (PMDs) balance moisture, relieve pain, limit inflammation, provide nutrients to the wound area, and are effective at continuously debriding, so routine rinsing is not advised.

The nurse, with an untrained assistant, applied standard-thickness and extra-thick silver PMDs for the first month, reducing infection risk, and non-silver PMDs thereafter. Donated PMDs of various configurations were applied almost exclusively from discharge day, secured by an elastic bandage and changed when saturated (initially, 4 times/day). Dressing changes included no wound cleaning/rinsing. After the initial 5 day antibiotic course, no systemic or topical medications were used. Patient was offered, but refused, skin grafts.

Results: With use of PMDs, the man reported little-to-no pain. PMDs helped cleanse/debride and absorbed the drainage to wound closure. Dressing change frequency decreased as healing progressed. Left wound closed ~day 60. Right wound undermining closed ~day 100. Patient then moved back to his remote home area, with no clean water or healthy food, and performed wound care himself, requiring no supplies other than PMDs secured by a length of cloth. The nurse or assistant visited him monthly. His right wound closed without complications ~day 400.

Discussion: Using solely PMDs, there was slow but steady healing of full-thickness wounds, without grafts. For over a year this uneducated man cared for potentially fatal wounds with no complications or infection. Most wound care methods depend upon trained professionals, regular wound cleansing, clean conditions, nutritious diets, and/or skin grafts. PMDs were used successfully on wounds despite significant challenges.