Objectives: Provide a standard protocol for treatment of Stage II and Stage III pressure ulcers. Describe four cases utilizing this protocol.

Rationale: Four case studies are presented. For all wounds, PUC was placed in the wound bed, and TBC was applied periwound concurrently, or in wound bed and periwound as needed as healing progressed. Wound was then covered with either gauze or dry alginate. Sharp debridement of necrotic tissue was employed as needed. Pressure redistribution surfaces were utilized as needed. Most patients continued on TBC post-healing to prevent recurrence.

Patient 1: 54 year-old female with Downs syndrome, seizures, and incontinence. Patient developed gluteal ulcers when her alternating pressure mattress was inadvertently turned off. Wounds measured 3.0x4.5x0.05(left) and 2.0x2.5x0.025(right) on 10/21/04. Right gluteal wound healed at 12/20/04. Left 0.3x0.3x0.025 by 1/3/05 and fully healed at 2/14/05. (Figures 1&2)

Patient 2: 26 year-old male, wheelchair bound ST to spina bifida. Incontinent of stool and history of recurrent pressure ulcers. Wound at 2/1/05 measured 6.0x6.0x0.2. Wound reduced to 1.4x0.7x0.1 by 4/7/05 utilizing noted protocol. (Figures 3&4)

Patient 3: 40 year-old male, wheelchair bound ST to spina bifida. Incontinent of stool and history of recurrent pressure ulcers. Wound at 12/14/04 measured 2.5x5.0x0.15. Wound healed at 1/31/05 utilizing noted protocol. (Figures 5&6)

Patient 4: 83 year-old male presents with right heel pressure ulcer. History of HTN, COPD, PVD with fempop, gout, right heel ulcer with MRSA. Wound at 6/28/04 measured 2.5x2.6x1.0. Wound measured 0.7x1.0x0.025 at 8/12/04 utilizing noted protocol. (Figures 7&8)

Conclusion: µ PUC and TBC provided an effective treatment protocol in patients with recurrent Stage II and III pressure ulcers and significant co-morbidities. µ Patient compliance with treatment protocol and pressure redistribution surfaces improved outcomes. µ Continued use of TBC reduced recurrence of ulcers.

Support of Healthpoint, Ltd, for this project is gratefully acknowledged.