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Introduction:

Evaluation of a treatment regime to prevent lower limb amputation in a patient with a venous – arterial - lymphatic leg ulcer. The 66-years-old female patient had an extensive leg ulcer (28.6 cm2) that had been stagnant for three years (Fig.1). She is divorced, lives alone and has two daughters. She has a long history of severe rheumatoid arthritis and is a heavy smoker (25 cigarettes/day). She is somewhat mobile with a walker but spends most of her time in a wheelchair. Her nutritional status is moderate. Patient reported pain was VAS 8.5.

Methods:

The vascular surgeon has proposed an amputation, but the patient is adamant to keep her leg. She was therefore discharged from the rehabilitation clinic and received her care now in the community. She reports to be angry with the surgeon and is anxious about her future. Although her leg is slim there is edema present (Fig. 3). The wound bed is covered with 95% slough and a small amount of unhealthy looking granulation tissue is present (Fig. 2). Further vascular assessment and biopsies ruled out vasculitis and malignancies (Fig. 4 and Fig. 5).

Results :

After 8 months the ulcer area had reduced from 28.6 cm2 to 19.1 cm2 (66%) with a healthy looking wound bed. She has stopped smoking, her mobility has improved. The patient is motivated to continue with the treatment and is much more active than at the start of the treatment. She expressed that slowly but gradually she is getting back her life.

Conclusion :

The multidisciplinary approach provided effective care in the community enabling the patient to improve her condition to spare her leg.

Introduction:

Efficacy of a adebridement product and a bcollagen dressing on inflammation reduction and re-starting healing was evaluated in ten frail elderly patients with stagnating skin lacerations, treated in a nursing home setting. Skin tears often occur in these patients, due to their poor condition and their medication such as corticosteroids and anti-coagulants.

Methods:

Case ascertainment was used. Patients received a bcollagen dressing and a cfoam or an dalginate as a secondary dressing, for a maximum of 14 days, after which the bcollagen dressing was discontinued and the cfoam used as a primary dressing. A tubular compressione system was used to reduce oedema that was present

in the leg. Wound healing was assessed using clinical observation and digital photographs, comparing day 0 versus day 14 results. Patients were then followed up until wound closure.

Results:

Eight women and two men were included and completed the study period. Patients had a mean age of 76 years (ranging from 62-100 years). All included wounds had closed within 12 weeks of treatment. Two typical cases are included to demonstrate the results.

Conclusion:

The results indicate that the use of the bcollagen dressing stimulated wound healing in these stagnating wounds. Moreover the bcollagen dressing has effectively stopped the bleeding.

OBJECTIVE

To compare the clinical efficacy of a collagen dressing covered with a foam dressing with the same foam used as a primary dressing in stagnating granulating pressure ulcer patients.

METHOD

Patients were randomised to receive either a foam dressing (Suprasorb P; Lohmann & Rauscher) as a primary dressing (group A), or a combination of a collagen dressing (Suprasorb C; Lohmann & Rauscher) covered with the same foam dressing (group B).Wound fluid was collected and evaluated prior to treatment (day 0), and on days 3,7, 14 and 21 .The level and expression of matrix metalloproteinases (MMPs) MMP-2 and MMP-9, and tissue inhibitors of metalloproteinases (TIMPs) TIMP- I and TIMP-2,as well as elastase content in wound fluid and angiogenesis,were evaluated, comparing results on day 0 and day 2 I.Time to ulcer healing, reduction in ulcer area, safety of treatment, patient-reported ulcer pain and comfort of the dressing regimen were evaluated as secondary outcomes. Patients received standard preventive measures, in line with the pressure ulcer prevention guidelines.

RESULTS

Ten patients were included in the pilot; five were treated with the foam dressing (group A) and five patients received the collagen dressing, using the foam as a secondary dressing (group B).Wound fluid from group B displayed a significant positive effect on angiogenesis (p < 0.05) compared with group A. In the collagen and foam groupTIMP- I and -2 increased faster and levels were higher than in group A. Furthermore, MMP-2, MMP-9 (p < 0.04) and elastase in group B showed faster and greater decrease in levels, compared with group A, indicating a faster and superior reduction of inflammation. In both groups the ulcers started to heal, with a faster onset of healing for group B.

CONCLUSION

The results of this pilot support published data on the use of collagen dressings compared with foam for stagnating wounds, shown in clinical studies.

DECLARATION OF INTEREST

This study was supported with an educational grant by Lohmann & Rauscher GmbH.Apart from DrAbel, the sponsors had no role in the design or conduct of the study, in the collection, analysis and interpretation of the data, or in the preparation, review or approval of the manuscript. DrAbel gave input to the study design from a scientific perspective. None of the authors received administrative, technical or material support for the conduct of this study.The authors have no other relevant financial interests to declare.

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