Author: rory.oliver

Case 4

rory.oliver Uncategorized

Case 4: SNAP™ Therapy Diabetic Foot Wound

Patient information:
68-year old male
Wound history:
Trauma to dorsal foot from door.
Dimensons:
Prior to SNAP™ Therapy, the wound measured 70mm x 54mm with a depth of 4mm without undermining.
Comorbidities:
Diabetes Mellitus, Smoker, Peripheral Vascular Disease, Coronary Artery Disease, COPD, Hypertension, Hyperlipidemia.
SNAP™ therapy treatment:
The patient was treated with SNAP™ Therapy for 3 weeks until full granulation of the wound bed was achieved. Then SNAP™ Therapy was used in conjunction with a cellular tissue product for an additional 5 weeks.
Outcome:
Wound closure was achieved at 9 weeks post-initiation of SNAP™ Therapy.
Start of SNAP™ Therapy
Start of SNAP™ Therapy
Week 2
Week 2
Week 8
Week 8

Case 3

rory.oliver Uncategorized

Case 3: V.A.C. VERAFLO CLEANSE CHOICE™ Dressing − Diabetic Foot
Author: Douglas Duke, DO Director of Wound Care Flowers Hospital, Dothan, AL

INTRODUCTION
A 54-year-old male was admitted to the hospital with chronic left foot wound of unknown duration (Figure A). Patient comorbidities included hypertension, diabetes mellitus, and Charcot foot.
Baseline:
The patient was treated with an intravenous antibiotic regimen and underwent surgical debridement with excision of necrotic tissue (Figure B). Following debridement, the wound was managed with V.A.C. VERAFLO™ Therapy using V.A.C. VERAFLO CLEANSE CHOICE™ Dressing. The contact layer of the V.A.C. VERAFLO CLEANSE CHOICE™ Dressing was placed on the devitalized wound bed, followed by the cover layer. Fifty milliliters of a commercially available hypochlorous solution (Vashe® Wound Therapy Solution, SteadMed Medical, Fort Worth, TX) was instilled with a dwell time of 10
minutes, followed by 3.5 hours of continuous negative pressure at -125mmHg. After 2 days of V.A.C. VERAFLO™ Therapy, the V.A.C. VERAFLO CLEANSE CHOICE™ Dressing was changed (Figure C), and the wound bed displayed healthy granulation tissue with minimal devitalized tissue or thick slough. After 14 days and 4 dressing changes, therapy was discontinued. A human dermal collagen matrix (GRAFTJACKET™, Wright Medical Group, Memphis, TN) was then applied to the wound for closure (Figure D).
Patient data and photos courtesy of Douglas Duke, DO; Director of Wound Care, Flowers Hospital, Dothan, AL

As with any case study, the results and outcomes should not be interpreted as a guarantee or warranty of similar results. Individual results may vary depending on the patient’s circumstances and condition.

NOTE: Specific indications, contraindications, warnings, precautions and safety information exist for KCI products and therapies. Please consult a clinician and product instructions for use prior to application. This material is intended for healthcare professionals.

Copyright 2017, 2018 KCI Licensing, Inc. All rights reserved. Graftjacket is a trademark of Wright Medical Group. Unless otherwise designated, all trademarks are proprietary to KCI Licensing, Inc., its affiliates and/or licensors. PRA-PM-EU-00075 (08/18)

Figure A: Wound at presentation
Figure A: Wound at presentation
Figure B: Wound after debridement
Figure B: Wound after debridement
Figure C: Wound after first V.A.C VERAFLO CLEANSE CHOICETM
Figure C: Wound after first V.A.C VERAFLO CLEANSE CHOICETM
Figure D; Application of human dermal-collagen matrix
Figure D; Application of human dermal-collagen matrix

Case 2

rory.oliver Case Study

Case 2: PROMOGRAN™ Protease Modulating Matrix treatment on a partially healed
diabetic foot ulcer on amputation site
Author: José Luis Lazáro Martínez, Tenured Professor
Clinical Director, Head of Diabetic Foot Unit, Teaching Podiatric Clinic, Madrid, Spain

INTRODUCTION
A 60-year-old female presented with a partially healed diabetic foot ulcer (DFU) over 4 months’ duration on an open stump of the right leg, post-metatarsal amputation. The patient had been diagnosed with type 2 diabetes 20 years ago and also had a limb amputation of the left leg. The wound had stalled, and during this 4-month period, wound management included a protease inhibitor dressing. For this wound, PROMOGRAN™ Protease Modulating Matrix was selected according to the algorithm, which is based on the recommendations of the World Union of Wound Healing Societies’ Position Document Local Management of Diabetic Foot Ulcers¹. The wound had stalled (not decreased in size by less than 50% in 4 weeks) and exudate, slough and granulating tissue were present, which made the wound appropriate for PROMOGRAN™ Matrix use. A TIELLE ESSENTIAL™ Silicone Dressing was chosen as a secondary dressing to maintain a moist environment at the wound surface.
Baseline:
The wound measured 5.7cm (length) by 5.9cm (width) by 2.0cm (depth) (Figure 1). The wound bed was coated with sloughy debris (25%), granulation tissue (75%) with skin gaps from the anterior area to the posterior and irregular edges present. There was moderate serous exudate of a clear amber colour. The wound had not been painful during or between dressing changes, due to the patient’s neuropathy. The wound was prepared using surgical debridement to remove the slough and PROMOGRAN™ Matrix 28cm2 and a non-border TIELLE™ ESSENTIAL Silicone Dressing were applied. Dressing changes were scheduled for twice a week. Throughout treatment, the patient was instructed to rest and use a wheelchair to offload the wound.
Review 1 (7 days from baseline):
The wound size had reduced, measuring 5cm (length) by 5cm (width) by 2cm (depth), with sloughy tissue present on the bed of the ulcer (Figure 2). There was some strikethrough of exudate, but there was no leakage. The wound was prepared as before using surgical debridement, and PROMOGRAN™ Matrix was applied. Dressing changes were planned for twice a week.Review 2 (14 days from baseline):
The wound had increased slightly in size, with slough (40%) and granulating tissue (60%) present in the wound bed (Figure 3). Serous exudate was at a moderate level. The wound bed was prepared as before, and the PROMOGRAN™ Matrix and non-border TIELLE™ ESSENTIAL Silicone Dressing regimen was continued.Review 3 (21 days from baseline):
The wound measured 4.7cm (length) by 6.9cm (width) by 2cm (depth) (Figure 4), and there was a reduction in slough (30% of the wound bed). There was a moderate level of serous exudate. Dressing regimen with PROMOGRAN™ Matrix and non-border TIELLE™ ESSENTIAL Silicone Dressing and offloading continued as before.

Review 4 (28 days from baseline):
The wound had reduced further to 3cm (length) by 3.2cm (width) by 2cm (depth), and the wound bed now comprised70% granulation tissue (Figure 5). Serous exudate levels remained moderate with strikethrough present during dressing wear time.

Final comments
Over 4 weeks, this DFU reduced in size by 50%, and there was an increase in granulating tissue. Throughout treatment, the clinician and patient were both highly satisfied with the dressings, with the patient feeling positive about the current treatment plan healing the wound. Though the wound had not completely healed, the use of PROMOGRAN™ Matrix with a secondary dressing of non-border TIELLE™ ESSENTIAL Silicone Dressing progressed the wound to a healing trajectory, and continued to be used beyond the 4-week evaluation period.

During the 4-week period, dressing changes reduced to twice a week. The patient rated the comfort of the PROMOGRAN™ Matrix and non-border TIELLE™ ESSENTIAL Silicone Dressing as ‘very good’. The patient began to feel more comfortable and less anxious, especially as her left limb had previously been amputated. All these improvements combined helped to improve the quality of life and outlook of the patient.

  1. Wounds International case studies evaluation. Using advanced wound
    dressings in the local management of diabetic foot ulcers. London: Wounds International, 2018 (Suppl).
Figure 1. Baseline
Figure 1. Baseline
Figure 2. Review 1
Figure 2. Review
Figure 3. Review 2
Figure 3. Review 2
Figure 4. Review 3
Figure 4. Review 3
Figure 5. Review 4
Figure 5. Review 4

Case 1

rory.oliver Case Study

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

INTRODUCTION
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 .
Baseline:
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.
Review 1 (6 days from baseline):
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.

  1. Wounds International case studies evaluation. Using advanced wound
    dressings in the local management of diabetic foot ulcers. London: Wounds International, 2018 (Suppl).
Figure 1. Baseline
Figure 1. Baseline
Figure 2. Review 2
Figure 2. Review 2.
Figure 3. Review 3
Figure 3. Review 3
Figure 4. Review 4
Figure 4. Review 4