Case report – Female, 67 years old
causistic date: 24.06.2008, published: 24. 06. 2008
Dr. Veronika Slonková, Dr. Vladimír Vašků, CSc. (1st Department of Dermatology and Venereology of St. Anne’s University Hospital)
The patient is a 67-year-old retired female who has been treated for recidivating ulcerations on her left shinbone for 22 years. The current ulcerations have persisted for 11 months. The patient suffered from phlebothrombosis 23 years ago. No occurrence of surface phlebitis or erysipelas. Short-stretch bandage compression was worn regularly.
Epicutane tests proved a contact allergy to lanoline alcohols, formaldehyde, colophony and camomile. The patient is treated for a glucose tolerance disorder, besides that she is healthy. According to venous examination, the patient suffers from ulcerations of venous etiology on the basis of post-thrombotic syndrome. Pharmacological anamnesis: Detralex, Agapurin retard.
Objective finding: several distal ulcerations of irregular shape with partially granulating and partially coated base on the left shinbone (pic. 1). The area around the ulcerations was calm, only with noticeable desquamation. The total ulcerated area covered 27.5 cm2. The patient complained of very strong pain in the ulcerated area – No. 9 on the NRS (numerical rating scale).
The patient was included in the study of Traumastem biodress (hydrogencalcium salt of oxidized cellulose). Redressing of the ulcerations was performed daily at first and then after 2 days in a later phase. Before the application of Traumastem, ulcerations were treated with Dermacyn solution with subsequent application of zinc oil around the ulcerations and application of oxidized cellulose in the ulcerations. These were then covered by oily gauze, a layer of gauze and fixed by a hydrophilic bandage and 2 – 3 short-stretch bandages.
The application of Traumastem led to a gradual cleaning of the ulceration base, triggering granulation and, above all, a very quick epithelization of the edges (pic. 2 – 4). After 3 weeks, the area of all ulcerations had diminished by more than half (12.5 cm2). A very fast epithelization also continued during the second months of Traumastem therapy (pic. 5, 6).
After 8 weeks, the ventral ulcers on the shinbone were completely healed (pic. 7), in the other ulcerations epithelization developed very quickly from the edges. The total ulcerated area covered 2.9 cm2.
The patient confirmed a noticeable relief from pain already after one week of the therapy – No. 6 according to the NRS; after 2 weeks the pain was reduced to No. 4 on the NRS and after 6 week of the therapy the pain receded considerably (No. 2 on the NRS). The significant reduction of pain enhanced the patient’s quality of life even before the venous ulcers had healed – see the table below.
| T0 | T1 | T2 | T3 | T4 | T6 | T8 | |
| size of ulceration (cm2) | 27,5 | 21,9 | 17,5 | 12,5 | 10,1 | 6,1 | 2,9 |
|---|---|---|---|---|---|---|---|
| pain (NRS) | 9 | 6 | 4 | 4 | 3 | 2 | 2 |
Note: At the time of the clinical study, Traumastem biodress (hydrogencalcium salt of oxidized cellulose) was called Traumastem T. This information also applies to the galleries of photographic illustrations included in these casuistries.
