CLINICAL PROBLEM: 78-year-old female with advanced Parkinson's disease was admitted to a skilled facility for rehabilitation after a four day acute care hospitalization due to a fractured pelvis from a fall. She became extremely agitated and was sedated due to her violent behavior. Two days later, a pressure ulcer was noted on her left heel, which had not been elevated. Despite various topical dressings and pressure relief measures, the ulcer worsened. The peri wound area had various layers of tissue destruction, and the wound base became increasingly necrotic and odorous, to the point of questionable limb salvage. She was discharged from the skilled facility after three weeks, and began home health care. Off-loading was provided. A vascular evaluation was done, osteomyelitis was ruled out, and lab work was within normal limits with acceptable protein and prealbumin levels. Surgical debridement was not an option due to her fragile, complex Parkinson's management.

CURRENT CLINICAL APPROACH: The wound measured 3.2 x 3.0 cm, was cleansed with a wound cleanser¹ and debrided with sterile sharp instruments. An enzymatic debriding-healing ointment² was applied to the wound base, covered with a saline-soaked gauze, and changed daily.

PATIENT OUTCOME: Within one month, the necrotic tissue was debrided from the wound base. The depth was determined as a stage IV; with muscle involvement and close proximity to the bone. A negative pressure device³ was utilized to facilitate closure. Healing was achieved within ten weeks.

CONCLUSION: The enzymatic debriding-healing ointment² was a successful method of choice for conservative wound debridement in preparation for healing.

Financial Assistance/Disclosure: Smith & Nephew, Inc., Kinetic Concepts, Inc.

¹Dermal Wound CleanserŪ, Smith & Nephew Wound Management, Largo, Florida

²Gladase-CŪ, Smith & Nephew Wound Management, Largo, Florida

³VACŪ, Kinetic Concepts, Inc., San Antonio, Texas