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

1. E W M A 2 0 1 3 : E P 5 7 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. 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
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06-12-2011 13-07-12
Fig 1

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).
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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
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6. DEBRIDEMENT OF THE ULCERS AND SKIN
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Spot the *debridement product
Situation before debridement
Situation after debridement
*Debrisoft®, Lohmann & Rauscher

7. RESULTS
*Debrisoft®, Lohmann & Rauscher
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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. 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
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