EWMA 2013 - Ep560 - LIVING WITH A VENOUS ARTERIAL LYMPHATIC ULCER FOR FOURTY-SEVEN YEARS – A CASE STUDY
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EWMA 2013 - Ep560 - LIVING WITH A VENOUS ARTERIAL LYMPHATIC ULCER FOR FOURTY-SEVEN YEARS – A CASE STUDY

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A v/d Wijngaard1, RN, M de Ruiter2, Wound specialist & ET, D Modersohn3, Skin & lymphedema specialist ...

A v/d Wijngaard1, RN, M de Ruiter2, Wound specialist & ET, D Modersohn3, Skin & lymphedema specialist

1.wound and compression specialist, Lohmann & Rauscher, The Netherlands,
2.Evean zorg, Alkmaar, NH, The Netherlands.
3.Dermacura, Heerhugowaard, The Netherlands.

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  • 1. LIVING WITH A VENOUSARTERIAL LYMPHATICULCERFORFOURTY-SEVEN YEARS – A CASE STUDY A v/d Wijngaard1, RN, M de Ruiter2, Wound specialist & ET, D Modersohn3, Skin & lymphedema specialist 1. wound and compression specialist, Lohmann & Rauscher, The Netherlands, Alicevandenwijngaard@xs4all.nl 2. Evean zorg, Alkmaar, NH, The Netherlands. mruiter@evean.nl 3. Dermacura, Heerhugowaard, The Netherlands. info@dermacura.nl EP560EWMA2013 Scientific grant Lohmann & Rauscher
  • 2. Methods • Case ascertainment was used for the evaluation of a treatment regime to prevent lower limb amputation in a patient with a venous – arterial - lymphatic leg ulcer that persisted for 47 years. EP560EWMA2013 Fig 1: A deep painful (VAS 8,50) ulcer on her left leg containing 95% slough and 5% granulation tissue. There is oedema present in the whole leg.
  • 3. The patient • Medical status: The 77-years-old woman had a leg ulcer which had persisted over 47 years. She has a long history of arterial disease, had an infected stent, severe rheumatoid arthritis, anemia, factor V-Leiden and Buerger’s disease. She is mobile with a walker and her nutritional status is moderate. Medication consists of diuretics, beta blocker and pain medication. • Vascular assessment and biopsies: Ruled out vasculitis and malignancies. • Ulcer condition: Patient reported wound pain was VAS 8.50. Edema is present in both legs, ulcer size upon presentation: 28.6 cm2 ; the ulcer bed contained 95% slough and 5% granulation tissue. EP560EWMA2013
  • 4. Multidisciplinary team approach • Psychological counseling to help her cope better, education about her situation and enabling self care. • Low level laser treatment and manual lymph drainage. • Debridement with a *monofilament fiber product + PHMB. • Compression: **tubular device, only the first layer (± 10 mmHg). • A ***collagen dressing was used covered with an ****absorbent pad. *Debrisoft®, **Actico® Silk, ***Suprasorb® C, ****Vliwasorb® Adhesive, Lohmann & Rauscher EP560EWMA2013
  • 5. Results • After eight months the ulcer area had reduced from 28.6 cm2 to 19.1 cm2 (66%) with a healthy looking wound bed. • Her mobility had improved, she started driving again. • The patient is motivated to continue with the treatment and is much more active now. EP560EWMA2013 Lymphdrainage twice weekly performed by a skin and lymphedema specialist.
  • 6. Self care at home EP560EWMA2013 Fig 1: cleansing Fig 2: debridement with the monofilament* product Fig 4: Selfcare has motivated her to change to a healthier and more active life style. Moreover she reported dressing changes to be more confortable when she can do them herself. Fig 3: Collagen** dressing in place Fig 5: Light compression with one layer of a ***tubulair system *Debrisoft®, **Suprasorb® C, ***Actico silk®, Lohmann & Rauscher
  • 7. Wound evolution EP560EWMA2013 Fig 5: Result after 4 months Fig 1: Day 0 Fig 2: Day 0, swelling in both legs Fig 3: After one debridement session Fig 4: After 10 days Fig 6: After non-related hospital admission and poor wound care her ulcer deteriorated. Fig 7: Two weeks after discharge, debridement and wound care showed results. Fig 8: The cavity is filled with granulation. Fig 9: Epithelialization. Fig 10: Status 19-04-2012
  • 8. Conclusion • The multidisciplinary approach provided effective care in the community enabling the patients’ improved condition supporting her towards ulcer healing. EP560EWMA2013 04-12-2011 06-03-2012 04-04-2012 19-04-2012