Practice Dr. med. Gerald Engels (Wound net Kön)

Photo documentary

Patient data / anamnesis: 

52 years old, male, diabetic foot syndrome, condition after forefoot amputation 02/2016 left. PAOD grade II left, insulin-dependent diabetes mellitus type II, polyneuropathy, after acute renal failure with chronic renal insufficiency, after C2 intoxication. Hypokalemia, hypocalcaemia, hypertensive-diabetic nephropathy, central myocardial infarction left; arterial hypertension, hyperlipidemia, nicotine abuse. 

Patient is mobile with a forefoot relief shoe with a continuous sole and a compensating sole on the right side despite hemiparesis on the right side. The inpatient hospital stay lasted 60 days, due to fistula formation in the area of the wound medial forefoot area of 4 cm depth, a further amputation or lower leg amputation was suggested to the patient. 

Due to an incipient psychological depressive mood regarding the long hospital stay, the patient was transferred to the WZ® Wound Center Augsburg in April. 

Local therapeutic pre-treatment in the clinic was performed due to critical colonization with an antiseptic containing octenidine dihydrochloride + 2.0 g phenoxyethanol (Octenisept®) for wound cleansing. A silver-containing hydrofiber and an absorber dressing for wound coverage were selected as wound fillers. Due to the high exudation rate, the presence of wound odour prior to dressing removal and the critical colonisation mentioned above, dressing changes were performed daily. 

When the wound was examined in the WZ® wound centre, an edematous, reddened, slightly overheated wound environment was observed. In the area of the wound margin a strong hyperkeratosis formation was observed. This is partially very spongy in the plantar area. When the spongy hyperkeratosis is removed, a foetal wound odour can be detected. The wound bed is granulating and covered with fibrin. After removal of the fibrin layer, the granulation tissue is granular, but somewhat light pink. A strong, viscous cloudy exudation is present. 

The local therapeutic wound treatment was initially carried out as follows: 

Wound cleaning: Wet-dry phase trained according to Gerhard Kammerlander with a wound cleansing solution based on singlet oxygen (NaOCl) with sea water (ActiMaris®). A w/o-containing lotion with a lipid content of 27% (BL® - BasicLotion) was used for skin care and rubbing into the wound environment. 

Wound filler: Silver-containing hydrofiber with ethylenediaminetetraacetate (Aquacel® Ag + extraTM) 

Wound coverage: Zetuvit® plus10 x 20 cm. Fixation by means of an elastic bandage with cotton content and a lengthwise and crosswise elastic tubular bandage (Tubifast™ blue 2-Way Stretch Technology®). 

The bandage was changed daily by the nursing service. A weekly check was carried out in our WZ® Wound Centre. 

After one week of dressing removal, a viscous exudate appeared under Aquacel® Ag + extraTM, which remained between the wound bed and the hydrofibre due to its consistency and could only be absorbed to a limited extent by the hydrofibre. The exudate build-up inhibited the growth of granulation tissue. Similarly, the exudate from the fistula was only partially drained, and a behavior was observed. A conversion to LIGASANO® white, sterile 15 x 10 x 1 cm took place. The fistula was loosely tamponed dry with a LIGASANO® Mini Wound Band 100 x 1,5 x 0,4 cm. 

The fistula was closed with the LIGASANO® wound strip mini 100 x 1.5 x 0.4 cm and the amount of exudate was significantly reduced by continuous local therapy. In the area of the wound bed, a well supplied granular granulation tissue was found. No wound odour can be detected. A reduction of hyperkeratosis and maceration was clearly present under the treatment described above. 

Summary / Conclusion:

Due to the structure of the LIGASANO® PUR foam dressing, targeted exudate management or controlled absorbency vertical discharge could be achieved. The fibrin coating was significantly reduced by the mechanical stimulus of LIGASANO® white and the granulation tissue was promoted, as was a reduction in hyperkeratosis.