Case report – Male, 55 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 55-year-old male, a carpenter by profession, suffering from recurrent ulcerations on the right shinbone for 15 years. The current ulceration has now persisted for 8 months. 25 years ago, the patient suffered an injury with a subsequent fracture of the right shinbone. Phlebitis or erysipelas negated. Compression worn regularly. According to vascular examination, the patient suffers from ulcerations of venous etiology on the basis of post-thrombotic syndrome (CVI EI l. dx., class C6 in CEAP classification). The patient further undergoes treatment of hypertension and gastroduodendal disease, at that time without subjective problems. Pharmacological anamnesis: Agen, Lozap, Vessel Due F, Detralex, Agapurin retard. No allergies stated.
Objective finding: located on the right shinbone are 2 larger ventromedial ulcerations identified with partially granulating, slightly coated base, with several epithelized areas in the centre. These were surrounded by several minor surface ulcerations (pic. 1). The area covered by ulcers was 7.8 cm2. The patient complained of severe pain – No. 4 according to NRS (numerical rating scale).
The patient was included in the study of Traumastem biodress (hydrogen calcium salt of oxidized cellulose). Redressing of the ulcerations was performed daily at first and then after 2 – 3 days in a later phase. Before the application of Traumastem, ulcerations were treated with Dermacyn solution with subsequent application of zinc oil around the ulcers 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.
Already after one week, a relatively fast epithelization occurred, both from the edges and the centre, which is evident particularly in the most severely ulcerated area (pic. 2).
After 2 weeks, minor ulcerations had completely healed. There were still 2 ulcerations persisting on the right shinbone; the proximal one was almost healed and the distal one, which was the largest ulcer at the beginning of the therapy, was partially epithelized, as can be seen in pic. 3 (the ulcerated area covered 3.5 cm2).
After 4 weeks, the proximal ulceration was covered by squamous crust, the distal ulceration was largely epithelized (pic. 5), the ulcerated area covered 2.1 cm2. Over the following month, the ulcerations continued to heal very quickly. Two months after the trial had been launched (i.e. at its first conclusion) there was a minor ulceration persisting on the right shinbone, covering 0.8 cm2, the area around the ulcer was totally calm (pic. 7).
The patient confirmed a considerable relief from pain – see the table below:
| T0 | T1 | T2 | T3 | T4 | T6 | T8 | |
| size of ulceration (cm2) | 7,8 | 4,3 | 3,5 | 2,8 | 2,1 | 1,0 | 0,8 |
| pain (NRS) | 4 | 3 | 2 | 2 | 1 | 1 | 1 |
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.
