Introduction: 76 year old female admitted on 28.05.19. District Nurses requested admission to hospital after patient developed small black blistered area under R) knee measuring 2cm (L) x 1.5cm (W). The patient contacted them the following day as it had deteriorated rapidly extending over the front of her right leg measuring approximately 9cm (L) x 7cm (W).
Past medical history includes Type 2 Diabetes, Ulcerative Colitis, Diverticular Disease, Coeliac Disease, Breast Carcinoma, Osteoarthritis and Postural Hypotension.
Diagnosis: Pyoderma Gangrenosum.
Initial Treatment of Therapy: Dermatology had initially reviewed patient and larvae therapy was commenced. Requested Tissue Viability opinion and V.A.C. VERAFLOTM Therapy was then initiated on 04.06.19. At that point wound dimensions were 9.3cm (L) x 7.2cm (W). V.A.C. VERAGLO CLEANSE CHOICETM dressing was used on a 3.5 hour cycle with a 10 minute soak time with 34 mls instillation fluid of 0.9% Normal Saline and Negative Pressure Wound Therapy (NPWT) of -125mmHg.
Progress: Following 1st dressing change on 06.06.19 there was a significant difference to wound. Wound bed showed healthy granulation and a small reduction in size was noted. At 2nd dressing change on 08.06.19 wound had further reduced in size measuring 8.2cm (L) x 6.9cm (W). No additional surgical debridement was required. On 10.06.19 dressing was transitioned to V.A.C. VERAFLOTM Dressing which the patient remained on for a further 10 days when she was changed to traditional NPWT using an ACTIVACTM Therapy unit in preparation for discharge home. Dressing changes occurred every 3 days.
Discharge and Follow-up: Discharged home on an ACTIVACTM Therapy unit on 21.06.19. Followed up at home and in clinic fortnightly. ACTIVACTM Therapy unit discontinued on 12.07.19 and patient commenced on PROMOGRAN PRISMATM Matrix as primary dressing.
12.08.19 – Wound dimensions 6cm (L) x 4.5cm (W).
20.09.19 – Wound dimensions 5.5cm (L) x 4.2cm (W).
23.10.19 – Wound dimensions 3cm (L) at furthest point and 2cm (L) at nearest point x 1.7cm).
30.10.19 – Wound dimensions – 1.7cm (L) x 1.2cm (W).
Clinical Outcome/Conclusion: Reviewed patient on 29.11.19 after approximately 6 months of treatment initially with V.A.C. VERAFLO CLEANSE CHOICETM, followed by V.A.C. VERAFLOTM Dressing, traditional NPWT using ACTIVACTM and finally with PROMOGRAN PRISMATM Matrix. As seen in the last photograph the wound has almost healed.
V.A.C. VERAFLOTM Therapy was initiated in this case as it was felt the wound would benefit from instillation therapy to cleanse the wound in a controlled and consistent manner whilst simultaneously providing the benefits of traditional NPWT. It effectively cleansed the wound and removed all the debris enabling a clear view of the wound bed. The rapidity with which this occurred exceeded expectations and negated the need for additional surgical debridement which had been the expected outcome by the medical staff at the outset. Very quickly the wound margins decreased and healthy granulation tissue began to appear and the transition to V.A.C. VERAFLOTM Dressing took place and continued for a further 10 days when it was changed to ACTIVACTM Therapy in preparation for discharge home. When the NPWT was discontinued PROMOGRAN PRISMATM Matrix was chosen for optimisation of wound healing by providing an antimicrobial barrier as well as maintaining a moist environment to enable continued granulation formation and epithelialisation whilst managing the exudates.
Had V.A.C. VERAFLOTM Therapy not been initiated there is a real probability that his lady would have had an extended hospital stay therefore there is an economic value to this treatment as well as the physical and psychological impact it had on her well being from both fairly rapid initial wound healing along with an early discharge home.
Reference: Cheryl Lugton, Tissue Viability Specialist Nurse, NHS Borders