TREATMENT OF PRESSURE ULCERS IN TOES

WITH A NEW HYDRO-DESLOUGHING DRESSING*

A.E. VILLAR ROJAS(1) ,A.R. VILLAR HERNANDEZ(2)

N. PIELENSTICKER(3)

(1)Virgen Macarena Hospital, Sevilla, Spain (2) Isla Cristina Health Centre, Isla Cristina, Spain (3) Urgo GmbH, Sulzbach, Germany

*Brand name: the new hydro-desloughing fibre dressing is UrgoClean®

INTRODUCTION

39 year-old patient admitted to the Nephrology Unit with a medical diagnosis of type I

diabetes mellitus present for 32 years, with macro- and microvascular involvement,

retinopathy, neuropathy, dysautonomia, arteriopathy and diabetic nephropathy, anaemia,

treated on occasions with EPO and Fe IV, depression.

HbA 1c 11.5%, blood glucose 5 gr, until control of the same, in the last five days the patient

has presented a fever of 38.5°C.

On 26.03.12 the patient was assessed by the Integrated Wounds Unit.

He presented pressure ulcers on the pad of the big toe on both feet, that had developed in

one month, with a foul odour and necrotic wounds (sloughing), with surrounding cellulitis

on the left big toe, clinical signs of infection.

OBJECTIVES

Surgical desloughing of both wounds for cleaning and disinfection of the pressure ulcers,

cultures and antibiogram, preparation of the wound bed for discharge from hospital,

planned for 30.03.12, provision of psychological support and reassurance for the patient,

initiation of treatment with hydro-desloughing dressing* to eliminate slough, continuation

of treatments in the Pressure Ulcer Unit and providing Health Education to prevent new

ulcers.

*Brand name: the new hydro-desloughing fibre dressing is UrgoClean®

METHODOLOGY

The first step was to control the fever, essential for discharge. The grade II, III ulcers were

desloughed on 27.3.12. After 48 hours of desloughing, absence of fever. The patient was

not sure about discharge, we negotiated to continue treatment in the Wounds Unit.

Over the first four days daily treatments using mixed Enzyme+hydrogel, preceded by

cleaning with Polyhexanide-Betaine. On 29.03.12 a biopsy culture was taken from the bed

of the wound.

On 04.04.12 there was a positive result for Staphylococcus aureus, Treatment with

Levofloxacin 500 mg. 1 tablet for 7 days; on the day of discharge we began treatment with

a new hydro-desloughing fibre dressing* on both ulcers. Since the result of this

treatment was so positive, we continued this treatment until the last week, when we treated

with Zinc Hyaluronate+Meshed hydrocolloid.

D0 D1 D15

*Brand name: the new hydro-desloughing fibre dressing is UrgoClean®

METHODOLOGY

The patient was discharged on 28.05.12.The dressing was fixed with gauzes, mesh and

adhesive dressings. The treatment sequence was L,X,V, and in the month of May, with

local holidays, the treatments were carried out by the patient herself. We had to remove

hyperkeratosis on the skin around the wound with a scalpel at least twice a week. Given

her neuropathy and deformities at the heads of the metatarsals, the focus was placed on

the need to study this case at the School of Podology for the purpose of inserting insoles

and correcting the weightbearing.

A hyperoxygenated fatty acid emulsion was applied at each treatment.

D34

D51 D63

D21

RESULTS

Diabetic female patient with very poor blood glucose control, with daily imbalances, a poor

prognosis for healing of her lesions.

Effective granulation tissue was achieved, with epithelialisation of both ulcers in 59 days.

The insoles produced a lesion at the fifth metatarsal head on the left foot, which is why

there were not used again up until discharge, pending their correction.

The patient was provided with support and reassurance.

The hydro-desloughing fibre* in the dressing demonstrated its efficacy by removing the

slough, increasing granulation tissue and, in this case, which was particularly complex,

both ulcers were epithelialised using this product exclusively. Since this is a complex

anatomical area for fixing dressings, the ease with which they were applied and removed

was noteworthy.

Moreover, the patient was able to treat herself.

CONCLUSION

*Brand name: the new hydro-desloughing fibre dressing is UrgoClean®