Case 1: PROMOGRAN™ Protease Modulating Matrix for non-healing complicated wounds,
post-fasciotomy on the left foot
Author: Bettina Born, Head of the Diabetic Foot Department, Kreiskliniken Reutlingen GmBH, Reutlingen, Germany
A 53-year-old male presented with three open wounds on his left foot following an emergency fasciotomy for acute sepsis of the foot more than 4 weeks previously. The patient’s poorly controlled type 2 diabetes had previously resulted in amputation of the second and third toe of the right foot and neuropathic arthropathy. Before presentation, the patient’s wounds were managed using a gelling fibre dressing as the primary dressing and an appropriate moist wound healing secondary dressing. An emollient was applied to the periwound areas, and the dressings were changed every second day.PROMOGRAN™ Protease Modulating Matrix was selected for all three wounds, as healing had stalled and the wounds had not decreased in size by less than 50% in 4 weeks. Selection of this dressing was made according to the algorithm based on the recommendations of the World Union of Wound Healing Societies’ Position Document Local Management of Diabetic Foot Ulcers¹ .
The wounds had failed to progress within 4 weeks, and the condition of the wound bed for all wounds was rated as poor. The wound beds comprised 50% granulation tissue, 45% slough and 5% epithelial tissue (Figure 1). The wounds produced low levels of thin serous exudate, and there was no odour or signs of wound infection. The patient had not been experiencing pain between or during dressing changes, likely due to their neuropathy.The wounds were prepared using sharp debridement. PROMOGRAN™ Matrix was cut to size and applied to all three wounds, and ADAPTIC TOUCH™ Dressing was applied as an atraumatic secondary dressing, held in place by a retention bandage. An emollient was applied to the periwound area, and the patient had been given oral antibiotics and advised to remain on complete bed rest. The dressings were planned to be changed every 3 days.
The wound bed in all three wounds had improved, with more epithelial tissue and a cleaner wound bed — 70% granulation tissue, 20% slough and 10% epithelial tissue. Low levels of thin serous exudate continued to be produced. The patient commented that the dressing regimen was very comfortable during wear time and he was hopeful that the wounds would continue to heal. The wounds were prepared with sharp debridement as per clinical protocols, and the current treatment regimen was continued alongside a recommendation for bed rest.
Review 2 (13 days from baseline):
The wound beds now comprised 75% granulation tissue, 15% slough and 10% epithelial tissue (Figure 2), and the low level of exudate continued to be serous and thin. The wound was prepared with sharp debridement, and the treatment regimen continued as before with dressing changes every third day. Limited, gentle mobilisation of the patient was introduced slowly.
Review 3 (20 days from baseline):
The wounds comprised 75% granulation tissue, 10% slough and 15% epithelial tissue, and the clinician commented that they looked clean and red, with healthy granulation tissue and more epithelial tissue (Figure 3). The dressing regimen with offloading was continued as before.
Review 4 (24 from baseline):
The wound bed now comprised 75% granulation tissue, 5% slough and 20% epithelial tissue (Figure 4), and thin serous exudate continued to be produced at a low level. The clinician decided to continue using PROMOGRAN™ Matrix.
Final comments
For this individual with stalled non-healing wounds, the use of PROMOGRAN™ Matrix had helped to reduce the size of the wounds and improve the wound bed composition, moving these wounds onto a healing trajectory. The patient rated the comfort of the combined dressing regimen of PROMOGRAN™ Matrix and ADAPTIC TOUCH™ Dressing during wear time as ‘excellent’, and both clinician and patient were highly satisfied with the treatment. The combined dressing regimen with antibiotic therapy helped improve to the quality of life of the patient because the wound improved faster, and fewer dressing changes were required compared to the previous dressing regimen.
- Wounds International case studies evaluation. Using advanced wound
dressings in the local management of diabetic foot ulcers. London: Wounds International, 2018 (Suppl).
