Case studies

Case reports of LIGASANO® in

Pressure ulcer

Treatment of pressure ulcers with LIGASANO®

Case report 1 - Treatment of a sacral ulcer

51 years, male, paraplegia, with extensive sacral ulcer.

Fig. 1: Condition before treatment with LIGASANO® white
Fig. 2: Treatment with LIGASANO® white wound dressing
Fig. 3: After several dressing changes, the wound is already much smaller and cleaner.
Fig. 4: Condition one week after surgical intervention

Excerpt from an observational study of the Accident Hospital Targu-Mureş, Romania. To read the complete report, please click here


Case report 2 - Photo documentation Haus St. Martin, Aldrans (Austria)

Photo documentation Haus St. Martin, Aldrans (Austria)

Fig. 1: Picture taken on 13 January 2005
Fig. 2: Picture taken on 21st January 2005
Fig. 3: Picture taken on 9 June 2005

Case report 3 - Pressure ulcer grade II on the right trochanter

Patient data and anamnesis:
60-year-old female patient, multiple sclerosis, completely immobile, grade II decubitus on the right trochanter, severe contractures on arms and legs, poor general condition. The patient is on an alternating pressure system, is extremely difficult to store due to her physical limitations and is constantly developing decubitus ulcers.

Fig. 1: 04.02.2016
Fig. 2: 04.02.2016
Fig. 3: 26.02.2016

Long-term grade 2 decubitus on the right trochanter with moderate exudation and redness around the wound. Supply with LIGASANO® white sterile 10 x 10 x 1 cm directly on the wound surface and 24 x 16 x 1 cm non-sterile in addition to pressure relief above. Fixation with adhesive fleece in the margin area. Dressing change every 2 days. Positioning of the patient on LIGASANO® sheets green and white for therapy support and pressure relief. Complete healing of the wound on 26.02.2016.


Case report 4 - decubitus on the rump with wet necrosis

Patient data and anamnesis:

Pressure sores on the rump with wet necrosis on an 89-year-old, completely immobile patient. There is also diabetes mellitus with high blood sugar levels and MRSA infection. The patient is only partially oriented and capable of contact. For some weeks mobilization in the wheelchair is only occasionally possible. The care and nursing takes place via an outpatient nursing service 3 times a day and a home care service instead.

The patient lies on a alternating pressure system and is stored. The urine excretion is passed through a urostoma. There is a fecal incontinence with frequent stool frequencies. So far, the decubitus was performed with a fine-pored foam dressing in three-day rhythm. This treatment resulted in no result. Exudate levels are moderate.

Fig. 1: 02.02.2016
Fig. 2: 02.02.2016
Fig. 3: 02.02.2016
Fig. 4: 10.02.2016
Fig. 5: 19.02.2016
Fig. 6: 09.03.2016

Fig. 1: 02.02.2016
Initially, a mechanical wound cleaning with polyhexanide solution and LIGASANO® Wundputzer® (wound cleaning sponge) intensive and soft was performed.

Fig. 2: 02.02.2016
Tamponade of the small undermining at 3 o'clock and covering of the wound surface with LIGASANO® white wound strip mini.

Fig. 3: 02.02.2016
Covering the wound area with LIGASANO® white sterile 15 x 10 x 1 cm and 24 x 16 x 1 cm. Fixation with adhesive fleece at the margin area. Dressing change every two days. In support of this, the patient was stored on LIGASANO® green 55 x 45 x 2 cm and LIGASANO® white 59 x 49 x 2 cm.

Fig. 4: 10.02.2016
Further mechanical wound cleaning with polyhexanide solution and LIGASANO® Wundputzer® (wound cleaning sponge) intensive and soft. Complete replacement of necrosis by LIGASANO® alone.

Fig. 5: 19.02.2016
The moist necroses and coatings were increasingly removed by the treatment with LIGASANO® white. This results in an increase in wound depth. The surrounding skin with the smaller decubitus ulcers has calmed significantly and the lesions have healed.
The treatment is continued with the LIGASANO® white wound strip mini, the cover of the wound surface with LIGASANO® white sterile 15 x 10 x 1 cm and additionally with LIGASANO® white sterile 24 x 16 x 1 cm. Fixation with adhesive fleece at the margin area. Dressing change every two days.

Fig. 6: 09.03.2016
The entire surrounding skin is intact and non-irritant. The wound bed has cleared and shows granulation islands. Significant decrease in wound depth through granulation.


Author: Daniela Laskowski, nurse, wound expert from Fulda, correspondence through LIGAMED® medical Produkte GmbH

Case report 5 - Wound treatment with LIGASANO® for decubitus grade IV

Patient data:

59 years, female, cachectic, PVS state after ischaemic Insult, in palliative care. Several decubital ulcers (trochanter bilateral, both heels, sacral region, back) despite pressure-relieving measures

Course of wound healing:

Loosen the leathery adherent fibrin layers and the necrotic tissue with Cuitmed sorbact Gel and LIGSANO® white sterile 2cm as primary dressing. LIGASANO® gives the wound the necessary mechanical stimulus for wound cleaning and ensures the dissipation and absorption of the wound secretion as well as the cell debris.

With LIGASANO® 2cm wound dressing, the pressure relief on the wound and the surrounding skin areas is additionally ensured and excess skin moisture is removed by air circulation.

In order to be able to absorb the high amount of exudate during the cleaning phase, it is ensured by attaching a superabsorber as a secondary dressing with subsequent fixation by a film dressing.

After approx. 4 weeks it was possible to perform the dressing change every 3 days under the therapy with Cuitmed sorbact Gel + LIGASANO® white in 2cm thickness + superabsorber (reduced load in palliative situation) and to achieve a clear improvement of the wound condition.

Optimal wound conditioning and incipient epithelization on 11.12.2015. Granulation of the wound margin and marked reduction of the wound area until January 2016. Patient now deceased.


Author: Sabine Seifert, independent nursing assistant Wunde ICW e.V., Remchingen.

Case report 6 - Wound treatment with LIGASANO® in bedsores

Patient data and anamnesis:

83-year-old patient, immobile, home care since June 2015. Pre-existing conditions: Type 2 diabetes mellitus, incontinence, obesity

Fig. 1: 22.05.2015: Condition before placement in the nursing home
Fig. 2: 31.07.2015: Condition before application of LIGASANO®

Dressing change on 03.08.2015:

During the first dressing change, the wound was still contaminated and severely reddened. The intensive cleaning with LIGASANO® Wundputzer® was painless and very effective. The wound cavities and undermining were each padded with a LIGASANO® white wound strip mini to the margin of the wound and covered with a layer of LIGASANO® white sterile 10 x 10 x 1 cm. Fixation with breathable adhesive fixing fleece. Additional positioning of the patient on one layer each of non-sterile LIGASANO® green and LIGASANO® white. Dressing changes 3 times a week.

Fig. 3a and b: 03.08.2015 Left buttock: Wound cleaning with LIGASANO® Wundputzer® (wound cleaning sponge) intensive and Octenisept® wound disinfection
Fig. 3b: 03.08.2015
Fig. 3c and d: 03.08.2015 right buttock: Wound cleaning with LIGASANO® Wundputzer® (wound cleaning sponge) intensive and Octenisept® Wound Disinfection
Fig. 3d: 03.08.2015
Fig. 4a: 05.08.2015: LIGASANO® white wound strip mini during removal from the wound cavity.
Fig. 4b: 05.08.2015: wound bed has significantly less coatings.
Fig. 5a: 07.08.2015: Wound after removal of the LIGASANO® wound strip mini
Fig. 5b: 07.08.2015: Tamponating the wound cavities with LIGASANO® wound strip mini
Fig. 6: dressing change on 12.08.2015: wound free from coatings and well granulated.
Fig. 7a: dressing change on 17.06.2016: wound almost healed
Fig. 7b: 17.06.2016: Tamponating the wound cavities with LIGASANO® wound strip mini
Fig. 8: Wound condition on 16.09.2016: wound completely healed.

Conclusion on 16.09.2016:

Wound completely healed. The patient sweats a lot (due to various medications), which leads to maceration and new skin defects again and again. Therefore LIGASANO® white wound strip mini will be applied prophylactically.


Author: Helga Huber, Medical Assistant, VERAH, Niederbayern

Case report 7: Treatment with decubitus grade 2 with LIGASANO® white & LIGAMED® heel shoe

Patient data and anamnesis:

60 year old, completely immobile patient in bad general condition. Long-term multiple sclerosis. Strong contractures on both arms and legs. Provided in the home environment by an outpatient nursing service with family support. Again and again emergence of decubital ulcers, because the patient is extremely difficult to position due to her physical limitations and suffers from severe pain. She lies on an alternating pressure system. The patient is mentally active and fully oriented.

Fig. 1: 04.02.2016: decubitus grade 2 on the right heel / sole. Condition after wound cleaning with LIGASANO® Wundputzer® (wound cleaning sponge) intensive
Fig. 2: 04.02.2016: The pressure ulcer was treated with several layers of the sterile 10 cm wide bandage made of LIGASANO® white bandage sterile 10 cm. Fixation with LIGAMED® fix. The dressing change took place every three days.
Fig. 3: 04.02.2016: Heel release with individually manufactured heel shoe made of LIGASANO® white and LIGASANO® green.
Fig. 4: 16.02.2016: Epithelisation phase. The wound is somewhat dry, therefore more layers of the bandage were wound.
Fig. 5: 26.02.2016: Complete healing and epithelisation.

Author: Daniela Laskowski, nurse, wound expert from Fulda

Case study 8: Wound treatment with LIGASANO® and essential oils for decubitus ulcers

Patient data / anamnesis:

88-year-old patient, present after tetraparesis in sepsis with acute renal failure and spondylodiscitis BWK I and II, decubitus of the right buttock half, massive swallowing disorders. Admission to the hospice on 11.06.2015. 

Fig. 1: 16.06.2015: Condition of the wound before the start of treatment with LIGASANO
Fig. 2: 25.06.2015: The necrosis slowly dissolves from the edges.
Fig. 3: 01.07.2015: Necrosis is more and more dissolved.

On 16.06.2015 the situation was as follows: A dry necrosis measuring approx. 4 cm x 2 cm had clearly demarcated itself. The wound environment was visibly reddened and hardened during palpation. 

As aroma care mixture we decided for the "Wound care mixture A" according to Maria Hoch: 20 ggt Cajeput (Melaleuca cajeputi), 50 ggt Lavender fine (Lavendula angustifolia), 20 ggt Basil (Ocimum basilicum), 10 ggt Rose geranium (Pelargonium graveolens), 60 ggt Tea tree (Melaleuca alternifolia), 10 ggt Thyme linalool (Thymus vulgaris ct linalool), 20 ggt Thyme thymol (Thymus vulgaris ct thymol), 20 ggt Cinnamon bark (Cinnamomum verum) 

From the basic mixture we added 10 ggt to 100 ml NaCl 0.9%. We sprayed this solution onto the necrosis, let it dry slightly and covered the decubitus with a foam bandage. Unfortunately, no side storage was possible with us either. The patient was bedded on an alternating pressure mattress and we carried out micro positioning. All pressure exposed areas were rubbed with our "skin care oil" twice a day for decubitus prophylaxis: 15 ml jojoba oil (Simmondsia chinensis), 35 ml sweet almond oil (Prunus dulcis), 8 gtt lanvendel fine (Lavandula angustifolia), 5 gtt benzoin siam (Styrax tonkinensis), 2 gtt carrot seeds (Daucus carota). 

Fig. 4: 08.07.2015: The hard necrosis has completely dissolved and is now only centrally connected to the wound bed.
Fig. 5: 15.07.2015: Necrosis remains continue to dissolve, wound now very severely secreted, dressing change 2x daily
Fig. 6: 21.07.2015: Thick fibrin coatings on the wound bed, wound pockets become visible.

The size of the decubitus did not change significantly, but the necrosis continued to dissolve and so we continued unchanged until the following condition (Fig. 2.8.4) became apparent on 8 July 2015 when the dressing was changed: The hard necrosis had completely dissolved and was only connected to the centre of the wound bed. The wound edges were well supplied with blood, but also swollen. I reduced the number of drops of the basic mixture to 5 ggt per 100 ml NaCl 0.9%, as we now went directly to the wound treatment with the essential oils. 

A dressing change was carried out daily. 

On 15.07.2015 we recorded the condition of the wound again: Slowly we saw the full extent of the damage. Since the necrosis remains continued to dissolve, we got a better view "into" the wound. The decubitus went deeper than we thought. Now more wound secretion was emptied, so that we had to change the dressing twice a day. It seemed to use a cleaning. In order to catch the secretion better, we changed the dressing material. We now used a gently adhesive foam bandage, applied additional absorbent compresses and fixed everything with a transparent bandage film. In this way, the resulting wound odour was also to be contained. 

Another photo documentation on 21.07.2015 showed: The necrosis had completely dissolved, thick fibrin coatings "stuck" to the wound bed. The wound environment showed well supplied with blood, but still raised wound edges. In addition, wound pockets were now clearly visible. These were rinsed out with the wound care mixture, then the entire wound was sprayed again extensively. We retained the dressing technique. 

From 25.07.2015, a new cleaning phase of the wound seemed to begin, as significantly more wound secretion was formed again. At times, the wound had to be dressed 3 times a day so that a new treatment was discussed in the team. We opted for LIGASANO®, which was inserted exactly into the wound cavity. In addition, the wound was covered with another layer and absorbent dressings were used. Of course, everything was fixed again. We kept the direct wound treatment. 

The first successes were already apparent two days later. The dressing only had to be changed twice a day, as significantly more secretion was absorbed by the dressing material. The fibrin coatings became increasingly detached and the wound odour was clearly contained. The wound was still rinsed out and sprayed with the wound care solution each time the bandage was changed. 

Fig. 7: 02.08.2015: Fibrin deposits almost completely dissolved, wound cavity much better visible.
Fig. 8: 11.08.2015: Wound cavity well cleaned, no more perceptible wound odour.
Fig. 9: 17.08.2015: Only a small amount of fibrin remains on the wound bed.

On 02.08.2015 we recorded the condition of the wound again photographically: The fibrin coatings had almost completely loosened and the wound cavity was now much better visible. The wound bed appeared clean and well supplied with blood, as did the somewhat swollen wound edges. Wound exudate hardly formed and so there was no excessive wound odour. With this result we maintained the current wound care. 

We carried out the next photo documentation on 11.08.2015. The wound cavity had been well cleaned and there were hardly any fibrin deposits left. The necrosis was also completely resolved. The wound odour was also barely noticeable and the wound exudate had also strongly decreased in the quantity. The wound was still well supplied with blood without coatings and wound odour. 

I put together a new wound care spray: 2 ggt incense arabic (Boswellia sacra), 2 ggt benzoe siam (Styrax tonkinensis), 1 ggt camomile blue (Matricaria recutita), 3 ggt carrot seeds (Daucus carota), 4 ggt Lavender fine (Lavandula angustifolia), 2 ggt Myrrh (Commiphora molmol), 3 ggt Rose geranium (Pelargonium graveolens),[nbsp] 5 ggt Sea buckthorn pulp oil in 200 ml NaCl 0,9 %. The wound was treated with this mixture daily during the dressing change. 

The new photo documentation took place on 17.08.2015 and showed a small fibrin deposit adhering to the wound bed at 1 o'clock. The remaining wound was free of other coatings, hardly secreted and no wound odour was perceptible. The procedure for wound treatment was maintained. 

Fig. 10: 27.08.2015: Wound bed free of coatings, good granulation tendency.
Fig. 11: 13.09.2015: Wound visibly reduced in size, wound edges well supplied with blood.
Fig. 12: 27.09.2015: Further reduction of wound size and depth.

On 27.08.2015, the current wound situation was captured again photographically: The fibrin deposit at 1 o'clock had loosened, so that the entire wound bed was free of deposits. The wound showed a good granulation tendency and the dressing was changed as usual. 

On 13.09.2015 the wound had visibly decreased in size and depth. The wound edges were well supplied with blood and so we changed the dressing material. Furthermore, a strip of LIGASANO® white sterile was inserted into the wound cavity for tamponade of any wound secretions that might occur. Then the wound was covered with a Zetuvit absorbent dressing and fixed with Opsite foil. The wound mixture was retained. 

On 27.09.2015 the wound depth was further reduced by granulation tissue. The wound margins were well supplied with blood and the wound size had further decreased. At this wound condition, we maintained the current treatment until 6.10.2015. Then a purulent greenish coating had formed on the wound. 

In addition there was a very bad smelling wound odour and so the wound care spray was adapted: 6 ggt Manuka (Leptospermum scoparium), 6 ggt Niauli (Melaleuca viridiflora), 4 ggt Chamomile blue (Matricaria recutita), 10 ggt Lavender fine (Lavandula angustifolia), 10 ggt Palmarosa (Cymbopogon martini), 4 ggt Immortelle (Helichrysum italicum), 8 ggt Peppermint (Mentha piperita), 10 ggt Sea buckthorn fruit oil in 200 ml NaCl 0,9%. We kept the wound material and changed the dressing daily. 

Fig. 13: 10.10.2015: Further wound reduction
Fig. 14: 15.10.2015: Further wound reduction
Fig. 15: 15.10.2015: Further wound reduction

On 10.10.2015, i.e. two days later, the wound dressing had already reduced significantly and there was no longer any perceptible wound odour. So it seemed that we were on the right track and so we continued. 

Another photo documentation was carried out on 15.10.2015: The wound bed was again completely free of deposits and granulated visibly. A wound odour was no longer perceptible. The entire wound was reduced in size. 

We carried out the last photo documentation on 25.10.2015: The healing tendency of the wound was still evident. The wound was completely free of irritation. The treatment of the wound with essential oils was agreed with our team of doctors at all times of the treatment. Since the general condition of the man had stabilised, the accommodation in a hospice was no longer suitable. With the family in the apron already for a better accommodation for him was looked for and thus the transfer took place on 26.10.2015 into an old people's home.  

After almost one month our guest has settled in very well and enjoys his gained quality of life. While most of him wanted to lie in bed in the same position, he is regularly mobilized into the wheelchair and takes part in the employment program. 


Author: Tanja Kapell, specialist nurse for anaesthesia and intensive care, aroma expert, Bodelschwingh-Hospiz Haus Franz, Dülken 

Case study 9: Wound cleaning & wound treatment with LIGASANO® for decubitus ulcers

Patient data and anamnesis: 

53-year-old dark-skinned man with complete paraplegia sub Th8 after occupational accident 1996, after recurrent decubitus ulcerations in the past years, colostoma attachment December 2015, VY Plastik gluteal 2017; after anasarca, cardiomyopathy, diabetes mellitus type II. 

Currently large-area, superinfected decubital ulcer stage 4 sacral: 

  •     Length 13 cm, width 7 cm, depth approx. 1 cm, wound margin 0.2 cm undermined 
  •     Wound margin very strongly macerated 
  •     no signs of inflammation 
  •     Exudate mediocre, odour inconspicuous, deposits (biofilm) visible 
  •     Tendency to bleed after mechanical debridement 

Wound treatment:

Compresses impregnated with sterile wound irrigation solution were applied to the wound for 15-20 minutes, after which the biofilm was removed intensively with LIGASANO® Wound Cleaner®. Then LIGASANO® white sterile wound dressing mini was inserted into the wound, covered with LIGASANO® white sterile 10x10x1cm, secondary covering with non-sterile LIGASANO® white. Fixation with Fixomull stretch and soft trousers. 

Fig. 1: 12.04.2017: Wound condition before start of treatment with LIGASANO® PUR foam dressing
Fig. 2: 12.04.2017: Mechanical debridement with LIGASANO® intensive wound cleaning sponge
Fig. 3: 18.04.2017: Wound is padded with LIGASANO® white non-sterile for pressure relief, fixed with adhesive film.
Fig. 4: 21.04.2017: Minimal undermining with LIGASANO® wound strip mini, clear exudate recognizable in the secondary dressing, daily dressing change required.
Fig. 5: 27.04.2017: Merging of the wound bed with the wound edge has clearly increased, the wound depth has decreased.
Fig. 6: 05.05.2017: Wound completely tamponed with LIGASANO® white wound strip mini up to the edge of the wound
Fig. 7: 15.05.2017: Pink, well-fed wound bed, beginning epithelisation phase recognizable
Fig. 8: 22.05.2017: Wound with LIGASANO® wound strip mini striped, daily dressing change continues
Fig. 9: 30.05.2017: Wound bed reacts moderately, pigment-free wound edge hard and well nourished

Interim results after two months of treatment with LIGASANO®: 

The wound develops relatively slowly towards healing. Only small steps in the right direction are visible. Concomitant diseases in the patient make the process more difficult. Intensive controls and stamina were particularly in demand here. Intensive cooperation with the team was necessary. Good arrangements with the family doctor were essential. 

Fig. 10: 13.06.2017: Wound margin appears horny and avital, but shows increasing activity in the direction of the connection to the wound bed, wound is now significantly smaller; clean wound bed.
Fig. 11: 20.07.2017: Wound continues to show small developmental steps, derailed diabetes and another wound on the trochanter slow down the healing process.
Fig. 12: 25.07.2017: Surgical debridement at the BG Klinik Murnau
Fig. 13: 12.09.2017: Despite abundant exudate and massive biofilm, a seamless transition from the wound bed to the wound edge has developed.
Fig. 14: 07.11.2017: After trochanteric surgery and stable FC values, rapid progress now; wound reduced in size by half; wound edge soft, no pigment, well nourished.
Fig. 15: 14.12.2017: Wound closed! soft, rosy skin formation on the wound bed, wound edge levelled.
Fig. 16: 28.05.2018: The patient has recently started using LIGAMED® heel shoes together with an insert made of non-sterile LIGASANO® white as a preventive measure.


In consideration of the patient's wishes for freedom (daily excursions of more than 6 hours in a wheelchair or daily showering), the generally desolate general condition (kidney, thyroid and FC values) and a severely infected fistula wound at the trochanter, the wound has healed under consideration of sterile wound care. The basic conditions in a patient with cross-section are a great challenge in wound treatment due to the skin temperature fluctuations that are difficult to assess (sweat formation, cooling or overheating). A good success in only 8 months. 

Authors: Advivo ambulante Beatmung GmbH, Munich, under the direction of Carola Boser, PDL, Dr. med. Luis Antonio da Silva Jäger, Munich