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MB is 38 year old male who injured his left medial leg in 1998, while weed wacking.
Initial visit at Banner Baywood wound clinic was Nov. 27, 07. MB’s history includes NIDM, HTN, closed head injury, obesity, and bilateral LE edema secondary to venous insuffiency, and history of DVT withGreenfield filter placement.
MB was seen in a wound clinic out of state, until seen by us. Treatments used by them included enzymatic debriders and silver alginate with compression therapy, either unna boots or compression stockings. Surgical treatments included 2 STSG to site with failure, and MB had undergone HBO therapy with out closure.
Treatment started at Banner Baywood wound clinic on Nov. 27, 07. Treatment till April 09 involved use of compression wraps, both long and short stretch, or 30-40 mm hg compression hose, with use of silver alginates, silver foam, silver collagen, and medihoney to the wound bed. MB was debrided on a regular basis and cultured several times being placed on oral antibiotic therapy for bacteria found by culture. He also started using a lymphedema pump April 2008. He was seen by a vascular surgeon and had venous closures twice to this site, last one February 09. Skin substitures were tried twice with no improvement. March 09 AIC was 7, protein levels were normal, CBC, ESR and CRP were normal. MRI was negative and last culture was negative. MB’s chart was reviewed by plastic surgeon who did not feel he could help this patient. On initial visit 11-27-07 wound area was 8.95 cm2. Wound area on 4-1-09 visit was 8.04 cm2.
Silver alginate with short stretch compression wraps were continued till June 27th, 09. On this date patient was switched to cadexomer iodine and 4 layer, long stretch, compression wrap that was changed weekly. At this time the wound area was 5.89 cm2. In July 09, MD had TCPO2 testing that showed limited healing potential. Each week the wound bed had debridement and the wound bed and wound edges were treated with silver nitrate. On 8-12-09 wound was closed. He was wrapped with long stretch compression wrap for 2 more weeks, and reopened with very minor wound that closed by 9-9-09 visit.
Respectfully submitted by Carole Dalbey RN, BSN, CWS, Dr. Christine Davis MD, CWS and DR. Kenneth Pettit DO, RN, CWS
Initial visit at Banner Baywood wound clinic was Nov. 27, 07. MB’s history includes NIDM, HTN, closed head injury, obesity, and bilateral LE edema secondary to venous insuffiency, and history of DVT with
MB was seen in a wound clinic out of state, until seen by us. Treatments used by them included enzymatic debriders and silver alginate with compression therapy, either unna boots or compression stockings. Surgical treatments included 2 STSG to site with failure, and MB had undergone HBO therapy with out closure.
Treatment started at Banner Baywood wound clinic on Nov. 27, 07. Treatment till April 09 involved use of compression wraps, both long and short stretch, or 30-40 mm hg compression hose, with use of silver alginates, silver foam, silver collagen, and medihoney to the wound bed. MB was debrided on a regular basis and cultured several times being placed on oral antibiotic therapy for bacteria found by culture. He also started using a lymphedema pump April 2008. He was seen by a vascular surgeon and had venous closures twice to this site, last one February 09. Skin substitures were tried twice with no improvement. March 09 AIC was 7, protein levels were normal, CBC, ESR and CRP were normal. MRI was negative and last culture was negative. MB’s chart was reviewed by plastic surgeon who did not feel he could help this patient. On initial visit 11-27-07 wound area was 8.95 cm2. Wound area on 4-1-09 visit was 8.04 cm2.
Silver alginate with short stretch compression wraps were continued till June 27th, 09. On this date patient was switched to cadexomer iodine and 4 layer, long stretch, compression wrap that was changed weekly. At this time the wound area was 5.89 cm2. In July 09, MD had TCPO2 testing that showed limited healing potential. Each week the wound bed had debridement and the wound bed and wound edges were treated with silver nitrate. On 8-12-09 wound was closed. He was wrapped with long stretch compression wrap for 2 more weeks, and reopened with very minor wound that closed by 9-9-09 visit.
Respectfully submitted by Carole Dalbey RN, BSN, CWS, Dr. Christine Davis MD, CWS and DR. Kenneth Pettit DO, RN, CWS