BH WOUND CARE | Case Study 106

Michael D., a 60-year-old male with a medical history of type 2 diabetes mellitus, hypertension, and peripheral vascular disease, presented with a long-standing arterial ulcer on the dorsal left foot. Despite previous attempts with various dressings, the wound had not shown signs of healing. Michael also had a functioning vascular stent in his left leg.

• Age: 60
• Medical History: Type 2 diabetes mellitus, Hypertension, Peripheral vascular disease
• Wound Duration: Prolonged, non-healing
• Previous Treatment: Various wound dressings
• Presenting Symptoms: Arterial ulcer on the dorsal left foot

The primary objective of this case study was to document the successful treatment of Michael’s non-healing arterial ulcer, which had been resistant to prior interventions. The treatment aimed to achieve wound healing, improve overall vascular health, and prevent future complications.

1. Wound Identification: Initial patient assessment, comprehensive history, Ankle-Brachial Index (ABI) measurement, and examination for venous pigmentation.
2. Venous Studies: Given the absence of abnormal pulses and an unremarkable ABI, Michael underwent venous vascular studies, Doppler ultrasound, and reflex studies to rule out deep vein thrombosis (DVT), venous reflux, and infection.
3. Skin Care: Resolution of cellulitis and application of skin moisturizer to maintain skin integrity.
4. Nutrition: Dietary modifications, smoking cessation, and lifestyle changes to optimize overall health and promote wound healing.
5. Management of Ulcer: Regular wound assessments, utilization of moist dressings, wound debridement, and management of bacterial bioburden.
6. Reduction of Edema: Assessment and management of edema through measures such as avoiding prolonged sitting or standing, leg elevation, compression bandage application, and lymphedema management in patients with phlebolymphedema.
7. Ultra-Mist Therapy: Administered 1-2 times per week to aid in wound healing and tissue regeneration.
8. Amniotic Tissue Application: Utilization of amniotic tissue for its regenerative properties by covering with adaptic non-adherent contact layer and securing with moisture retentive dressing. 
9. Prevention Plan: Implementation of measures including the use of compression stockings, leg elevation, offloading, and ongoing lifestyle modifications.
10. Wound Healing: The ulcer achieved complete healing in 14 weeks.

• First Dressing Change: Significant signs of healing were evident at the first dressing change.
• 3 Weeks: Substantial improvement in wound appearance and size was observed at 5 weeks.
• Fully Healed at 14 Weeks: The wound achieved complete healing and closure marking a successful outcome.

This case study highlights the successful treatment of a long-standing arterial ulcer in a patient with type 2 diabetes, hypertension, and peripheral vascular disease. Through a comprehensive treatment protocol that addressed wound care, vascular health, edema management, and patient education, the ulcer achieved complete healing in 14 weeks. Early signs of improvement were evident, underscoring the effectiveness of the chosen interventions and emphasizing the importance of a multidisciplinary approach to wound management in complex medical cases.