CLINICAL PROBLEM: 69-year-old male, retired physician, with deformities of the lower legs and feet from polio. He lives at home with paid caregivers. Since he is non ambulatory, he wears a brace on the right leg and sits in a scooter most of the day with his feet dependent. A stage IV pressure ulcer developed on the distal aspect of is right foot, from the pressure of his foot on the floor. He is insensate. There is a high volume of exudate and odor is present.

CURRENT CLINICAL APPROACH: The wound measured 7.5 x 6.5 cm, and was covered with necrotic slough. An enzymatic debriding-healing ointment¹ was applied, covered with saline-soaked gauze, and changed daily until we could visualize the wound base and extent of injury. Once this was achieved, a cadexomer iodine gel² was used when packing the wound depth. A custom scooter was obtained for moderate leg elevation and pressure relief.

PATIENT OUTCOME: Within ten weeks, the necrotic tissue was debrided. The depth was determined as a stage IV pressure ulcer, with muscle involvement and close proximity to bone. Packing the wound twice weekly removed debris, decreased odor, and managed the exudate. Granulation tissue is now present, and measurements improve weekly. There is some peri wound yeast.

CONCLUSION: The enzymatic debriding-healing ointment¹ was a successful method of choice for conservative wound debridement and the cadexomer iodine gel² controlled the exudate, bacteria, slough and debris in preparation for healing a stage IV pressure ulcer.

Financial Assistance/Disclosure: Smith & Nephew, Inc.

¹Gladase-CŪ, Smith & Nephew Wound Management, Largo, Florida

²Iodosorb, Smith & Nephew Wound Management, Largo, Florida