Here - EWMA 2013

POSTER PRESENTATIONS
P 364
OPTIMIZING PERIULCER SKIN BEFORE NEGATIVE PRESSURE WOUND
THERAPY
Poster: Case Study
Birgitte Vinter 1 , Mette F. Nielsen 1 , Karsten Fogh 1
1 Dept. of Dermatology, Aarhus University Hospital (Aarhus, Denmark).
Aim: Patients on negative pressure wound therapy (NPWT) often have changes of the
periulcer skin such as contact dermatitis or stasis dermatitis. We demonstrate a strategy
to protect and treat dermatitis of periulcer skin in a patient treated with NPWT.
Method and patient: A 66 year old woman with a venous leg ulcer for 10 months
admitted to the department of dermatology for treatment with NPWT. No healing occured
during the previous 8 weeks despite standard treatment and compression. Periulcer skin
was characterized by irritative dermatitis and there was an ulcer measuring 7.3 cm 2
behind the left medial malleolus. Treatment of the periulcer skin prior to initiation of
NPWT: potassium permanganate (3%, 15 min), a thin layer of betametasone creme,
(followed by drying of the skin for 10 min) and application of methylrosanilinium 5mg/ml.
Treatment performed once daily for 3 days. The wound was treated with sharp
debridement followed by moist wound treatment (hydrogel) and compression. NPWT
was started 4 days after admission (changed every 2-3 days).
Results: Treatment of the periulcer skin for 4 days prior to NPWT resulted in a marked
improvement and NPWT could be carried out as planned combined with compression.
NPWT was carried out for 4 weeks and the wound area was reduced by 62%. The
improvement of the periulcer was maintained throughout the treatment period.
Conclusion: Intact periulcer skin is pivotal for successful treatment with NPWT and our
treatment strategy seems to be a way to handle periulcer skin before and during NPWT.
POSTER: CASE STUDY
P 365
Poster: Case Study
CHALLENGES IN COMPRESSION OF PATIENTS WITH SEVERE LYMPHEDEMA
Connie Winter 1 , Jes Velling 1 , Wilja Dam 1 , Karsten Fogh 1
1 Dept. of Dermatology, Aarhus University Hospital (Aarhus, Denmark).
Aim: To describe challenges in compression of patients with severe lymphedema.
Lymphedema can be primary and secondary, the latter being caused by compromised
flow in the lymphatic vessels due to surgery and other causes. Therefore, there is a need
for compression which often can be challenging do to anatomical changes of the
extremities involved.
Methods: Patient records of 4 patients with secondary lymphedema were retrospectively
reviewed for causes of lymphedema, associated diseases, diagnostic procedures, skin
changes and characterization of the lymphedema. All patients received high pressure
compression with short- or long stretch bandage and when needed combined with
intermittent pneumatic compression (IPC). At the end of treatment with circular
compression bandage either compression stockings or newly developed compression
bandages.
Results: Combined venous insufficiency and lymphedema associated with obesity: a
combination of compression, gastric banding and liposuction resulted in marked
reduction of edema. Secondary lymphedema associated with testis cancer: despite trials
with basically all available compression methods no reduction in edema could be
obtained. Severe lymphedema associated with Klippel Trenaunay Weber syndrome:
reduction of edema with combined short- and long stretch bandages and IPC, but
maintenance therapy is challenging. Severe lymphedema associated with obstruction in
the pelvic region: edema difficult to control despite the use of relevant compression
methods.
Conclusions: Experience from these patients shows that adequate compression of
these severe cases of lymphedema is challenging in terms of selection of the relevant
method for compression and maintaining treatment results. Motivation and compliance of
the patient is pivotal for optimal results.
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