2005 Symposium on Advanced Wound Care | |
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Case Study
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Goodbye pyoderma gangrenosum! Hello prosthesis! Sharon Anderson, BSN, MA, MSCC, Kaiser Permanente, Sacramento, CA Pyoderma gangrenosum is an often-idiopathic ulcer with a characteristic appearance of an undermined necrotic blush edge and a peripheral erythematous halo. The current case deals with a 75 y.o. female with a 4-year history of a non-healing right leg ulcer with a biopsy diagnosis of PG, recalcitrant to medical management. The lesion progressed to a chronic underlying osteomyelitis. The purpose of this case report is to discuss the initiated management. The patient was managed over 4 years with a wide spectrum of modalities, including topical debriding agents, Dakins dressing changes, vacuum assisted closure, multiple silver agents and Cyclosporin/Predisone trials. The surrounding skin was severely atrophic due to the chronic steroid application. X-ray, nuclear studies and MRI studies demonstrated progression to bony involvement with osteomyelitis. The patient became despondent with the failed responses and continued pain and agreed to transtibial amputation. At 2-week follow-up the incisional wound demonstrated probable local PG recurrence. Wound care with enzymatic debridement, carboxymethyl cellulose (CMC) fiber dressing with ionic silver was initiated a daily basis. Over a 2-month post-operative period the wound improved weekly with subsequent complete closure. Rapid, successful wound closure was accomplished with (CMC) fiber* dressing with ionic silver protocol of care. * AQUACEL® Ag Hydrofiber® Dressing with Ionic Silver, ConvaTec, a Bristol-Myers Squibb Company, Princeton, NJ |
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