2005 Symposium on Advanced Wound Care | |
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Case Study
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Calciphylaxis induced leg ulcer treated successfully with bi-layered living skin construct* and negative pressure therapy† Desmond P. Bell, Jr., DPM, CWS, DAPWCA, First Coast Diabetic Foot & Wound Management Center, Jacksonville, FL; De Anna M. Bell, MSN, ARNP, BC, AAPWCA, Wound Care on Wheels, Jacksonville, FL Ulcers resulting from calciphylaxis may appear initially as necrotic, painful lesions, often in the lower extremities of patients with End Stage Renal Disease. Calcification of underlying blood vessels supplying the skin may result in tissue death. A renal dialysis patient with an ulcer of her right leg, the result of calciphylaxis, was successfully treated using multiple modalities. The ulcer progressed from multiple mottled lesions with central necrosis on the lateral portion of the leg, to a single eschar measuring approximately 10.4cm x 3.7cm. Treatment consisted of surgical debridement of eschar and moist wound care to prepare the site initially. Negative pressure† was applied to the ulcer at a setting of 75/continuous three weeks post debridement of eschar to enhance perfusion and increase granulation in the wound prior to placement of a bi-layered living skin construct. A graft* of a bi-layered living skin construct unit was fenestrated, cut, and applied to the ulcer. Negative pressure therapy was continued for one week after graft placement to reduce deleterious effects of wound exudate to the graft. The patient’s pain level decreased significantly after graft application, with resolution of ulcer at ten and one half weeks post graft. *Apligraf® is a registered trademark of Novartis, Inc., East Hanover, NJ ©2004, Organogenesis, Inc., Canton, MA †V.A.C.® Therapy™ is a registered trademark of KCI (Kinetic Concepts Incorporated), San Antonio, TX ©2004 |
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