Paths to Practice Perfection
Wound Management of Venous Leg Ulcers in the Right Lower Extremity Limb
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Patient:
A 68-year-old male presented for care with lymphedema and multiple, copiously draining ulcerations on the right lower extremity (Figure 1). Symptoms were present for years and failed to respond to compression, foam dressings, or abdominal pads. Previous medical history included hypertension requiring use of anti-hypertensive medication.

Figure 1. Right leg venous leg ulcer at presentation.

Diagnosis:
The patient presented with lymphedema and multiple ulcerations on the right lower extremity with copious amounts of drainage. A positive Stemmer sign was noted and palpable pedal pulses with mild symptoms of venous insufficiency were noted. He was diagnosed with lymphedema and venous leg ulcers.

Course of Treatment:
The patient underwent sharp debridement followed by 3M™ Kerramax Care™ Super-Absorbent Dressing and 3M™ Coban™ 2 Two-Layer Compression System (Figure 2). The dressing was changed 3 days later and revealed that the copious drainage had dramatically decreased (Figure 3). Therapy was continued with weekly dressing changes. After three weeks, treatment was changed to 3M™ Kerracel™ Ag Gelling Fiber Dressing and Coban 2 Compression System.

2. One week after application of Kerramax Care Dressing along with Coban 2 Compression System. The wound surface was dry to the touch.

Figure 3. Drainage was incorporated in the dressing.

Discharge and Follow-up:
After 1 month, the ulcer had healed and the edema almost completely resolved (Figure 4). A support garment was prescribed, and pneumatic compression was ordered for daily use. A lymphedema therapist was recommended. The patient has continued to do well with only mild exacerbation of symptoms.

Figure 4. Lower extremity 1 month after Kerramax Care Dressing along with Coban 2 Compression System use.

Treatment Modalities:

  • Sharp debridement
  • Kerramax Care Super-Absorbent Dressing
The Kerramax Care Dressings offer an advanced method of absorbing exudate from wounds utilizing Exu-Safe™ technology built into the dressing core. This super-absorbent core absorbs and retains moderate to high levels of fluid away from the wound bed – including bacteria and MMPs* - protecting delicate wound tissue and surrounding skin whilst helping to reduce the risk of maceration, even under compression. *As demonstrated in vitro
  • Kerracel Ag Gelling Fiber Dressing
The Kerracel Ag Dressing is a gelling fiber silver dressing that uses the combination of an enhanced carboxymethyl cellulose (CMC) dressing and the advanced silver technology – Ag Oxysalts™ Technology - to create the optimal wound healing environment. This dressing is the only gelling dressing with Ag Oxysalts™ Technology (Ag3+), providing up to 6 times more power than traditional silvers (Ag1+).
  • Coban 2 Two-Layer Compression System
The Coban 2 compression system provides therapeutic compression which has been shown to reduce edema and pain and improve daily activities. Plus, because the bandages are low-profile and comfortable to wear, patients are more likely to wear them longer.
  • Support garment
  • Daily use of pneumatic compression after ulcer healed

Conclusion:

The ulcer was completely epithelialized after 1 month of treatment with Kerramax Care Dressing and Kerracel Ag Dressing along with Coban 2 Compression System. The patient's edema was almost completely resolved with just mild exacerbation of symptoms. The use of these products in combination with other treatment modalities helped support the management of the ulcer that had been present for years and failed to respond to other therapies, by maintaining an environment conducive to healing.

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Patient data and photos courtesy of Robert J. Snyder, DPM, MBA, MSc, CWSP, FFPM RCPS (Glasgow), Dean, School of Podiatric Medicine, Professor and Director of Clinical Research. Director, Fellowship Program in Wound Healing and Clinical Research, Barry University School of Podiatric Medicine.
Note: Robert Snyder is a paid consultant for 3M products.

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 instructions, contraindications, warnings, precautions, and safety information exist for these products and therapies, some of which may be Rx only. Please consult a clinician and product instructions for use prior to application.

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