The Significance of DNA-Targeted Wound Management for 21 Year Old Recalcitrant Wounds

 Recalcitrant wounds are difficult to heal₁, sometimes fatal, and are costly financially, physically, and emotionally for patients. These non-healing wounds affect between 3-6 million people in the United States and are estimated to cost the US Healthcare System up to $25 billion annually₂.

A 77 year old male patient with multiple 21 year old venous stasis ulcers on the left lower extremity was assessed for final topical treatment recommendations due to worsening of the ulcers, exposed malleolar bone, and impending left lower extremity amputation. Five ulcers, ranging in size from 2cm in diameter to 14cm x 10cm, all with depths of 1.5 cm were present. All ulcers presented with purulent, foul odor drainage. Tissue specimen was obtained for DNA analysis of the exact bioburden of the ulcers. DNA results yielded multiple aerobic pathogens within the ulcer beds. Prescription lipid-based gel with targeted antibiotics was formulated to target the precise pathogens in the ulcers. Prescription gel was applied topically daily and secured with secondary gauze dressing. Systemic antibiotics were concurrently implemented.

All ulcers progressed rapidly through the healing process, with complete closure achieved in 5 weeks time. Parallel to the improvement and eventual closure of the ulcers, the patient's quality of life was dramatically enhanced. As his pain decreased, his use of narcotics decreased leading to increased appetite, participation in social activities, and ultimately attending physical therapy sessions for strengthening exercises and mobility.

Recalcitrant wound, which are defiant to traditional treatments, may benefit from an expedited, targeted management program which combats the bioburden of the wounds directly. As outlined in this patient's experiences, the victory of healing wounds stretches far beyond skin deep.