HISTORY: 68-year old male with diagnosis of chronic non-healing sacral ulcer x's 4 months. Complex medical history – congestive heart failure, severe generalized debility, chronic renal failure requiring hemodialysis, severe peripheral vascular disease with previous right leg bypass procedure, and left below knee amputation, history of recent severe anemia of unclear etiology, hypertension with orthostatic hypotension, coronary artery disease, status post successful resuscitation of cardiopulmonary arrest, and diabetes mellitus with autonomic neuropathy. Also, hyperlipidemia, obesity, history of depression with psychotic features, and recent hyperkalemia.

TREATMENT

Treatment included: IV antibiotics for infection, Flagyl and Vancomycin, Tri-laminate polyurethane hydro cellular foam. The patient was put on an alternating pressure mattress, 2-hour side-to-side turns, limited time up in chair. Dietary was consulted to increase protein. We started with a pre-albumin of 6, increased it to 24 after 3 weeks. The wound was cleansed with normal saline. No sting skin prep and pink foam dressing were applied.

OUTCOME

The wound on admission measured 17.5 x 14.0 x 1.0 cm., with moderate amount of exudate. Second week: 12.5 x 12.0 x 0.8 cm., yellow slough remains, 25% granulation with moderate amount of exudate. Week #3: Three separate areas open, islands formed in between. The areas measured: 2.0 x 2.5, 8.0 x 3.0, and 3.5 x 3.0 cm., depth on all areas was 0.5 cm. 50% granulation. Re-epitheliazation appeared. Week #4: one area 6.0 x 2.7 x 0.4. Week #5: 4.0 x 2.0 x 0.2 depth. Week #6: area closed.

Discharged after six weeks of treatment. The wound was closed with mild erythema remaining. Patient/caregiver education included nutrition, wound healing, skin care, frequent repositioning and support services.