PROBLEM Ten-year-old girl in Ghana developed R-heel pressure ulcer one year previous. Occasionally, herbal poultices applied, but usually not treated. Arrived at clinic without dressing. Small stones embedded in 1.5cmx2.0cmx0.3cm deep wound. Beneath copious beige drainage thick slough covered woundbed. Pain constant, severe.Inability to bear weight limited her ability to carry heavy head-loads. Chronic protein, micro-nutrient malnutrition, malaria and intestinal worms. Humidity always less than 20%, over 110ºF daily.

RATIONALE/METHODOLOGY Dressing needed to reduce pain, stay in place as girl did chores. Keeping woundbed moist in arid setting while inhibiting infection challenging. Use of standard foam and hydrogel dressings led to dramatic fungal and bacterial infections in this very warm setting. Polymeric membrane dressings reduce wound pain, aid in preventing infection and donate moisture to wounds while absorbing excess drainage. Clinician had observed immediate granulation in stalled chronic wounds through use of polymeric membrane dressings previously. Therefore, after initial cleansing and sharp debridement, extra-thick polymeric membrane dressings were applied directly to wound and changed every two-to-three days when saturated. Wound cleansing necessary only once more, when wound became grossly contaminated with debris. Treatment also included antimicrobials for malaria and intestinal worms, prayer and daily multivitamins plus nutrition teaching. Due to chores, could not elevate foot, but she usually kept heel off ground.

RESULTS Pain immediately reduced. Infection resolved without systemic intervention. Patient worked throughout treatment. Moisture became appropriate and granulation tissue formed quickly. Healing slowed due to unresolved severe protein malnutrition. None-the-less, wound healed completely in three weeks. Thick polymeric membrane dressings provided effective wound management for this pressure ulcer of one year's duration from initiation of treatment to complete wound closure while generally eliminating the necessity of wound cleansing.