Statement of clinical problem:

A 54-year old Caucasian male presents with recent history of contusion to medial aspect of left lower calf (#1).  Past medical history consistent with Type II diabetes mellitus, chronic obesity and lymphedema.

Description of past management:

The treating physician evaluated patient and manual debridement was performed removing overlying hematoma resulting in a 20.3 x 14.3 cm Stage II ulceration (#2). Initial treatment consisted of enzymatic debridement using chlorophylline copper *, gauze* and elastic bandages on a daily basis. The patient's pain rating was a 10/10 on a 0-10 verbal analog scale.  Pain management consisted of a fentanyl patch with scheduled oxycodone and additional oxycodone 10 mg/acetaminophen 650mg**** (2) prn every 4-6 hours and a premedication prior to daily dressing changes. This regimen had minimal impact on the patient's pain. Total daily opioid use exceeded 380 mg of equivalent morphine (McCaffery & Pasero, 1999). 

Current Clinical Approach:

It was our decision to use biocellulose as a biological dressing in order to decrease the end nerve exposure to the environment.  Biocellulose was applied with an immediate decrease in pain and a consistent 3/10 pain rating over an 8-week period. A dressing change was performed at week 8 (#3) and premedication was given but was manageable with low dose opioids. 

Patient Outcomes:

The patient demonstrated a significant decrease in the need for opioid use during the healing process. The patient has no current need for additional oxycodone or daily premedications.

Conclusion:

Utilizing biocellulose provided our team with an approach to pain control while decreasing the need for long-term opioid use and enhancing the healing process in an otherwise complicated wound.

* Dermafillª, AMDRitmed, Inc.  Montreal, Canada

** Panafilª Healthpoint, Ltd.

*** Kerlixª Kendall, Mansfield, MA

****Percocet 10mg /Acetaminophen 650mg