Here - EWMA 2013

POSTER: CASE STUDY
Poster: Case Study
P 354
TOTAL TREATMENT APPROACH OF A DIABETIC PATIENT WITH TROPHIC
ULCERS – A CASE STUDY
A.N. Begma 1
1 Federal State Budget Institution, State Scientific Center «Laser Medicine» Federal
Medical and Biolo (Moscow, Russia).
Introduction: A total treatment approach may be effective in complex cases. The aim of
this case study was to provide an integrated approach evaluating the efficacy of the
treatment regime per wound stage.
Methods: Case ascertainment was used. The 68-year-old female patient has had
diabetes type 1 for 18 years and a history of cerebral vascular accident. Since 2010 she
had an ulcer on her anterolateral right leg which had increased from 9 cm 2 to 50 cm 2
within six months. She was admitted to the hospital with an even larger ulcer of 138 cm 2 .
Her venous circulation and arterial blood supply was normal. The 0.3 mm deep ulcer
contained 32% black necrosis and 68% slough. Wound edges and peri-ulcer skin looked
healthy. Patient reported ulcer pain was VAS 7.4.
A *hydrogel was applied on the black necrosis and an **alginate covered the rest of the
ulcer. A ***film was used as a secondary dressing. Dressing changes were every two
days.
Results: After 9 days slough had reduced to 28% of the ulcer surface. Patient reported
pain was VAS 3.2. The dressing regime was changed to a ****bio-cellulose dressing +
PHMB covered with a film dressing with twice weekly dressing changes, until complete
wound bed preparation, after three weeks. After skin grafting for protection a
*****hydrocolloid was applied for 7 days.
Conclusion: The dressing regime was shown to be effective and allowed for
comfortable ulcer closure.
*Suprasorb ® G
**Suprasorb ® A
***Suprasorb ® F
****Suprasorb ® X + PHMB
*****Suprasorb ® H, Lohmann & Rauscher
P 355
WHEN OEDEMA REDUCTION IS NOT ENOUGH
– CASE STUDY OF A LYMPHEDEMA PATIENT
Poster: Case Study
Ria van Dam 1 , Alice van den Wijngaard 2
1 Boerhaave Foundation for Nursing homes, location: St. Jacob (Haarlem, Netherlands);
2 Lohmann & Rauscher (Almere, Netherlands).
Aim: Management of patients with lymphedema is well established in the Netherlands.
However it is not evident that outcomes are successful. Aim of the case study was to
identify risk factors and to correct flaws in the patients’ treatment regime, leading to
successful outcome.
Method: Case ascertainment was used in the 80 year-old non concordant female patient
with combined venous lymphatic ulceration. Mainstay of lymphedema treatment is skin
care, exercise and compression with rigid bandages. To optimise concordance it is
important to analyse the individual patient issues and to adapt the treatment regime
accordingly. The ulcers on both her forefoot and lower legs had recurred due to friction of
ill-fitting shoes and socks. The other ulcers on her lower legs had closed. The complete
regime was revised, using a less bulky *two component compression system, a
**collagen dressing and specialist lymphedema footwear.
Results: Skin lesions and ulcers were closed within 6 weeks and the reduction of edema
was 12 cm (measured at the calf) per week for the first 3 weeks. After 4 months of
treatment the patient was fitted ready to wear compression stockings for maintenance
therapy, continuing with skin care and specialist footwear.
Conclusion: To prevent recurrence, identification of risk factors, optimizing concordance
with maintenance therapy is key. The less-bulky compression system allowed for better
fitting of footwear. Ulcer healing and reduction of edema was achieved in a patientfriendly
and effective manner within 4 months of treatment.
*Rosidal TCS
**Suprasorb ® C; Lohmann & Rauscher
EWMA 2013
COPENHAGEN
15-17 May · 2013
Danish Wound
Healing Society
207