Middle-aged woman in rural Ghana developed multiple shallow bilateral lower leg ulcers from bites. Three months' topical treatment with chloramphenicol powder. Result: leather-like black eschar, but no healing. Largest (R calf) increased to 7.0cmx2.7cm. Patient came to clinic for treatment of acute malaria and UTI, but agreed to wound care. Denied wound pain. Protein deficit moderate. Water available for drinking and bathing extremely contaminated (turbid). Weather muggy. Lows > 90ºF highs 110ºF.

Since patient did not seek wound-care, quick healing necessary to achieve compliance. Avoiding infection was critical. Dressings needed to be comfortable and elastic enough to make good contact with wound surfaces as she walked long distances. Use of standard foam and hydrogel dressings led to dramatic fungal and bacterial infections in this very warm setting. Polymeric membrane dressings, however, have demonstrated ability to aid in preventing infection. Also flexible, comfortable and donate moisture to dry wounds while absorbing excess drainage. This clinician had observed dramatic healing of other wounds through use of polymeric membrane dressings.

Treatment included oral antimicrobials for malaria and UTI, nutritional teaching, prayer and direct wound care. Black eschar peeled off easily, revealing clean hypergranulation. Extra-thick polymeric membrane dressings applied directly to wounds, changed every-other-day. Wound cleansing not needed. Elevating feet not possible due to rigorous housework.

No wounds developed infection. Patient worked throughout treatment. Hypergranulation resolved; wounds filled in quickly. Wound healing slowed due to protein malnutrition, trauma to R shin wound, and resistant malaria (treated x3 in three weeks). None-the-less, wounds completely closed in 28 days. Thick polymeric membrane dressings provided quick and effective wound management for all of her ulcers from initiation of treatment to complete wound closure.