CLINICAL PROBLEM: Family members brought an 81 year-old male patient to hospital emergency department for bilateral leg ulcers, acute respiratory distress, and chest pain.

Patient claims these ulcerations recently appeared. While living in Mexico he was using assorted topical treatments, including rubbing the legs with herbs and twigs. Patient is obese, diabetic, hypertensive, on a daily maintenance dose of prednisone with frequent temporary increased due to acute asthma attacks. The full-circumference bilateral lower extremities had ischemia and gray areas with overlying necrosis. Wound culture grew enterococcus. Physical, social, emotional issues significantly impact this patient outcome.

MANAGEMENT: After receiving surgical debridement as an outpatient for several weeks, the patient was admitted to the long-term care unit. Due to age and cardiac risk, further surgical debridement was not recommended. Based upon the painful nature of these wounds and other wound characteristics, the team selected cadexomer iodine and an absorbent secondary dressing to reduce the bacterial burden, manage odor, absorb exudate and debride the wounds. Protective paste was applied to periwound skin to minimize maceration. Dressings were changed every other day.

PATIENT OUTCOMES: After one month, necrotic tissue was significantly reduced and the wounds were granulating, allowing the team to use other advanced wound care products to maintain moisture balance. Patient was discharged to his family after six months in the long term care unit.

CONCLUSION: Despite co-morbidities, the staff was able to effectively manage this patient's leg ulcers with the use of cadexomer iodine.