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Case Study/Series
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Sequential Use of Advanced Technologies in the Management of an Unusual Limb Threatening Venous Ulcer First Author: Roger Schechter Authors: Ann Moore A 61 y/o female with a history of venous leg ulcers presented 2 weeks s/p hospitalization for an infected pretibial ulcer. In addition to the unusual location, this very large and deep ulcer was quite aberrant, exhibiting thick tenacious necrotic eschar and multiple tracts that drained sero-purulent fluid, extending to exit sinuses many centimeters distant from the main wound. Initial management consisted of debridement of eschar, excision of tracts, and single layer graded compression bandaging. Cultures were consistently negative; yet development of new tracts was observed weekly, requiring subsequent sharp excision. Granulation tissue covered the floor of each excised tract within one week of "de-roofing". Complete closure of this limb-threatening wound required combining advanced therapies. Compression bandaging* continued throughout the course of care. Vacuum assisted closure** managed drainage and edema, preparing the wound bed for sequential application of bilayered skin substitute***. Skin substitute was applied utilizing standard technique, flat upon granulation tissue, as well as with the novel method of rolling product with fibroblast layer outward and then tucking it into remaining tracts and undermining. A single application brought about wound closure in six weeks. Compression stockings prevented recurrence and the patient was referred for possible Greater Saphenous Vein Closure. * Setopressª High Compression Bandage, ConvaTec, Princeton, NJ ** VACª, KCI Inc., San Antonio, Tx. ***Apligraf¨, Organogenesis, Inc., Canton, Mass. |
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