Here - EWMA 2013

POSTER PRESENTATIONS
P 396
The role of modern dressings in the management of venous
ulcers
Poster: Case Study
Sandra Marinović Kulišić 1 , Suzana Tunuković 2
1 University Hospital Center Zagreb, Department of Dermatology and Venerology, School
of Medicine (Zagreb, Croatia);
2 Stoma Medical (Zagreb, Croatia).
Aim: A 54-year-old female patient was admitted to Department of Dermatology and
Venereology at School of Medicine, University Hospital Centre Zagreb with deep
secerning chronic venous ulcer with visible extensive fibrin layers on her right tibia,
which were there for the last 4 years.
Method: Therapy was administered using bioclusive dressings and defined by the
assessment of wound status and by the classification of chronic wounds with previously
performed bioptate of ulceration for microbiological analysis and pathohistological
verification.
Results: On the venous ulcer antiseptic dressings were applied, enzymatic debridement
was performed, bioclusive dressings were used – Ag hydrofiber dressing with silver
(Staphylococcus aureus was isolated in bioptate of ulcus) as the primary dressing and
as the secondary dressing polyurethane film dressing with systemic antibiotic treatment
using antibiogram. Two weeks upon introduction of the therapy a partial epitelisation was
achieved, the defect of ulcer was filled with granulation tissue, the size of the ulcer
diminished, as well as swelling and redness of surrounding skin and the pain, secretion
and fetor receded. By application of antiseptic measures, covering the ulcus with
bioclusive dressings and administering the systematic antibiotics the healing of chronic
venous ulcer was initiated.
Conclusion: This case report makes an example of a treatment of chronic venous ulcer
by application of systemic antibiotics where they were absolutely indicated due to clinical
signs of critical colonisation with auxiliary treatment using modern bioclusive dressings.
POSTER: CASE STUDY
P 397
Poster: Case Study
Experience using circumferential wrap technique with polymeric
membrane dressings in an ischemic diabetic foot patient with a
complex lower leg skin graft
Amran Ahmed Shorki 1
1 Universiti Sains Malaysia, Kelantan (Kota Bharu, Malaysia).
Introduction: Type 2 diabetic with lower leg ischemia, often presented with untreated or
partially treated infected foot ulcers. Management includes initial ulcer debridement
followed with split-thickness skin graft. The aim was to develop a method to improve split
thickness skin graft outcomes in diabetic foot patients.
Methods: Patient presented with a chronic infected diabetic distal anterior shin ulcer.
Split-thickness skin graft was performed. A polymeric membrane interface dressing
(PMD) was applied to the site and a sterile polymeric membrane wrap (PMW) was
applied circumferentially extending above and below the grafted site.
Results: Historically, this ischemic patient’s graft usually takes two weeks to completely
adhere to the wound bed and around two months to be fully healed, at which time the
patient would only be discharged. In this particular case, the graft attached to the wound
bed 78% faster (3 days vs. 14 days). The site healed 75% faster (2 weeks vs. 2 months)
and patient was discharged 75% faster (2 weeks vs. 2 months).
Conclusion: Polymeric membrane dressings, when applied over the diabetic wound
graft site combined with the circumferential wrap technique accelerated healing in this
ischemic limb. This approach improved the clinical outcome while dramatically reducing
the cost of management and warrants further investigation. The approach was
undertaken because PMDs reduces swelling which leads to improve perfusion and also
has been shown to improve diabetic ulcer healing, donor site outcomes and flap
surgeries.
228