CHRONIC ULCER OF CHRONIC ULCER OF THE LEFT LEG AND HEALINGTHE LEFT LEG AND HEALING

L. Dubois, Independent State Registered Nurse, 02000 Laon

History of the wound

• September 2001

82-year-old patient, with a history of hypertension, suffering from a venous ulcer on the posterior face of the left leg. This is treated with Biatain® ulcer1 and heals

• November 2002

The general condition of the patient deteriorates, leading to exacerbation of the ulcer, as well as hospitalisation for one week.

• December 2002

Necrotic pressure ulcers on both heels and venous ulcer which spreads from the popliteal hollow to the heel of the left leg over a total length of 26 cm. Application of Tulle Ialuset® 2 .

Severe pain when the dressings are replaced, necessitating administration of morphine.

• February 2004

The pressure ulcers on the two heels are healed, while the venous ulcer remains clean without any healing being noted.

Management with Mepilex® 3 and Normlgel® 3.

D3

The wound no longer oozes following Mepilex® and Normlgel® application. Healing phase reached in less than two days and total absence of pain. Optimum result.

The quantity of exudate becomes moderate, the protective bandages and pads are clean.

The wound no longer gives off an odour, only slight pain persists when the dressing is replaced.

Venous ulcer on the posterior face of the left leg before treatment. Healing observed 3 months after start of management

D50

Progressive healing.The notable appearance of new wounds at the top of the leg reminds us, however, of the clinical context of a bedridden and anaemic patient. The result remains more than satisfactory

The result observed at 3 months shows faster progression, reduction and healing.

The great efficacy from the time of wound management has allowed us to achieve very rapid healing.

Dramatic improvement with regard to patient comfort, thanks to the simplicity and conformability of the products used, as well as almost immediate absence of pain on replacement of dressings.

Healing is simply a chain of successive stages during which the least interruption may result in pathological progression as well as making the wound chronic.

The objective of treatment is to speed up healing and improve patient comfort while averting the risk of infection.

Materials and Method

The new case management consists in applying:

• Mepilex® 10 x 20, a silicone-coated hydrocellular dressing used in the treatment of exudative wounds.

• combined with application of Normlgel®, an isotonic hydrogel.

Dressings replaced every 2 days.

D1

Clean wound, spreading as far as the severely damaged heel, but continuously oozing and recurring for more than a year. Size: 26 cm.

Large quantity of exudate

The wound gives off an odour but does not show any clinical sign of infection. The pain remains intense at the time when dressings are replaced.

How the lesions progress:

D7

Considerable reduction in ulcer observed. Size: 11 cm.

The heel is healed, but the quantity of exudate remains moderate.

No pain is felt by the patient, either in the wound or on removal of the dressing.

D11

Wound measured at 9 cm. Clear regression in just 12 days.

The exudate is small in quantity and of a bloody nature.

1 : Coloplast2 : Genévrier S.A.3 : Mölnlycke Health Care