Case report - Female, 83 years old, recidivating ulcerations on both shinbones
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 an 83-year-old female with recidivating ulcerations appearing on both shinbones.
The patient is being treated for ischemic heart disease, hypertension, type II diabetes mellitus treated through diet and for hypothyroidism. She had an operation for arthrosis in both hip joints with insertion of complete endoprosthesis. In 2005, the complete resection of a malignant melanoma in her right cheek was carried out.
Ulcerations have been repeatedly occurring for 7 years on the left shinbone and 5 years on the right shinbone. The current ulcerations have now persisted since spring 2006. The patient did not suffer from phlebitis, she regularly wears compressions.
According to vascular examination, the patient suffers from venous ulcers of mixed etiology – on the basis of chronic venous insufficiency and diabetic peripheral angiopathy with prevalence of the venous component.
Objective finding: a rounded ulceration covering the area of 4.4 cm2 located on the right shinbone. The base of the ulceration was partially intensively granulating, partially covered with fibrinous layering, with apparent epithalization of edges, the area around the ulcer was calm (pic. 1a). On the left shinbone, an oblong ulceration was identified, covering the area of 10.1 cm2, with a granulating base, partially covered with fibrinous layer, almost traversed in the centre. The area around the ulcer was calm (pic.1b).
The patient was treated with Traumastem biodress. Redressing of the ulcerations was performed daily at first and then after 2 – 3 days in a later phase. The frequency of redressing was determined by the quantity of exudation. At first the absorption of Traumastem was rather fast, therefore redressing was made daily. Later, with the transition of ulcerations to epithelization phase of healing the quantity of exudate decreased, therefore Traumastem could be left in the wounds for 2 – 3 days until it was fully resorbed. During redressing, ulcerations were showered with subsequent application of compresses soaked in Jarisch solution for 15 minutes. The area around the ulcerations was treated by indifferent paste, then Traumastem biodress was applied, followed by oily gauze, square gauze and compresses and fixed by short-stretch bandages.
Already after one week, a very fast epithelization developed in both ulcerations, on the right leg (pic. 2a) as well as on the left leg where it was almost traversed (pic. 2b). Already after 2 weeks the ulceration on the left shinbone was fully traversed, forming 2 minor ulcerations (pic. 3b). After 4 weeks, there was a minor ulceration on the right shinbone, covering the area of 1.2 cm2, with an intensively granulating base and quickly epithelizing edges (pic. 5a) and 2 minor ulcerations on the left shinbone, with the size of 1.7 cm2 and 2.9 cm2, also with intensively granulating base and quickly epithelizing edges (pic. 5b).
The area around the ulcerations was calm, without any signs of eczematization. The right shinbone ulceration healed after 8 weeks (pic.7a); the left shinbone ulceration was almost healed after 8 weeks of the application of Traumastem biodress, with a persisting minor distal ulceration with the size of 1 cm2 with intensively granulating base and very quickly epithelizing edges (pic.7b).
After application of Traumastem, the patient confirmed a significant relief from pain, which considerably enhanced her quality of life already before the ulcerations had healed – see the table below.
| T0 | T1 | T2 | T3 | T4 | T6 | T8 | |
| size of ulceration (cm2) | 15,3 | 13,5 | 7,9 | 5,7 | 4,5 | 2,5 | 0,8 |
|---|---|---|---|---|---|---|---|
| pain(NRS) | 2 | 1 | 1 | 0 | 0 | 0 | 0 |
Conclusion
The above casuistry demonstrates a very positive effect of oxidized cellulose on wound healing. Its application triggered a very fast granulation and subsequently epithelization phase of wound healing. The patient noticed a significant reduction of pain in ulcerations, which improved her quality of life.
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.
