EWMA 2013 - Ep570 - WHEN PERCEPTION IS NOT REALITY – LEG ULCER TREATMENT OF A PATIENT WITH SCHIZOPHRENIA

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J Alblas,PA, RJ Klicks,MD, M Haenen,cma,
E Hein, cma, A Andriessen*, PhD

Published in: Health & Medicine, Business
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EWMA 2013 - Ep570 - WHEN PERCEPTION IS NOT REALITY – LEG ULCER TREATMENT OF A PATIENT WITH SCHIZOPHRENIA

  1. 1. E W M A 2 0 1 3 : E P 5 7 2
  2. 2. INTRODUCTION • Schizophrenia alters the person's ability to think clearly and behave appropriately. • He had venous ulcers on his right leg for over 5 years. E W M A 2 0 1 3 : E P 5 7 2 06-12-2011 06-12-2011
  3. 3. THE PATIENT • The 62-year old male suffered from diabetes, hallucinations and delusions. • He received ambulant treatment and medication for his mental condition, but concordance with treatment was poor. • Examination using Doppler was hampered as he expressed typical severe anxiety. • He presented with two extensive sloughy ulcers on his lateral right leg (Fig 1) and on the medial aspect of his right leg (Fig 2). Ulcer size: 9,4 x 4,8 cm and 12,4 x 6,9 cm. • He had moderate oedema, scabs and signs and symptoms of chronic venous hypertension. Fig 2 E W M A 2 0 1 3 : E P 5 7 2 06-12-2011 13-07-12 Fig 1
  4. 4. METHODS • Case ascertainment was used to evaluate the effectiveness of a debridement and wound treatment regime in this patient, who did not understand, nor trusted the need for treatment. • Study duration was 11 months with photographs and clinical evaluation. • Evaluations were at baseline (start) and twice weekly up to week 3 when wound cleansing was completed, after which there were monthly evaluations till ulcer closure (end). E W M A 2 0 1 3 : E P 5 7 2
  5. 5. TREATMENT REGIMEN • Wound and skin cleansing was performed upon dressing changes using a *monofilament debridement product wetted with polyhexanide. • The patient was encouraged to participate in the debridement and dressing changes, which gave him a sense of control. • The wound was then covered with an adhesive **superabsorbent dressing. • Rigid compression was delivered with a two layer ***tubular compression system. • Upon achieving wound cleansing the dressing regime comprised a ****collagen covered with a *****silver containing dressing. *Debrisoft®; **Vliwasorb®;***Actico Silk; ****Suprasorb® C ; *****Suprasorb AG; Lohmann & Rauscher E W M A 2 0 1 3 : E P 5 7 2
  6. 6. DEBRIDEMENT OF THE ULCERS AND SKIN E W M A 2 0 1 3 : E P 5 7 2 Spot the *debridement product Situation before debridement Situation after debridement *Debrisoft®, Lohmann & Rauscher
  7. 7. RESULTS *Debrisoft®, Lohmann & Rauscher E W M A 2 0 1 3 : E P 5 7 2 18-09-2012 05-10-2012 13-07-12 18-09-2012 05-10-2012 Fig 1: Ulcers are covered With slough Fig 3: Granulation and epithelium Fig 2: Ulcers almost clean Medial ulcers, Fig 1,2,3 Lateral ulcers, Fig 4,5 Fig 4: Ulcers are clean and granulating Fig 5: Ulcers are reduced in size. The patient is happy with the result, which has also Improved his mental condition and trust in his carers. Fig 6: A new ulcer developped 09-2012 when the other ulcers were healing well..
  8. 8. CONCLUSION A patient-centered approach together with debridement using the *monofilament product and wound bed preparation as well as effective compression lead to a successful outcome. Scientific grant: Lohmann & Rauscher *Debrisoft®, Lohmann & Rauscher Thank you for your attention E W M A 2 0 1 3 : E P 5 7 2

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