A complex case: Raynaud’s Phenomenon, contact burn to hand, negative pressure wound therapy and viagra

Ms Rebecca Schrale1

1Tasmanian Burns Unit Royal Hobart Hospital

51 year old female presented with bilateral hand burns at the Tasmanian Burns Unit, Royal Hobart Hospital. She sustained < 1% TBSA deep dermal contact burns as a result of having a seizure while cooking. Past History of Scleroderma, Raynaud’s Phenomenon, complex seizure disorder and GORD.

Treated conservatively with dressings, avoidance of cold and continuation of calcium channel blockers for 10 days with  little improvement. At day 10 plan made for debridement and split thickness skin grafting to full thickness burns to seven digits. Treatment plan as follows: Neurology and Rheumatology review pre op; constant warmed temperature in single room; commenced on Sildenafil (Viagra) 20 mg TDS as per Rheumatologist; strict elevation; negative pressure wound therapy (NPWT) and inpatient admission planned for 6 days.

At Day 5 there was a near 100% take of skin graft and nil seizure activity noted. Plan for outpatient follow up in Burns clinic for wound care, physiotherapy and scar management. Ceased Sildenafil 14 days post graft.

This case highlights the need for multidisciplinary review from multiple specialities and the use of NPWT and Sildenafil in patients with extremity burns with Raynaud’s phenomenon. In the future we would look at commencing this therapy on referral and first presentation.

I am an endorsed Nurse Practitioner in Burns and have been employed at the Tasmanian Burns Unit for the past 16 years. I am currently the Clinical Nurse Consultant of Burns at the Tasmanian Burns Unit at the Royal Hobart Hospital and coordinate the state-wide service

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