Case study review of a new gelling foam dressing in the management of 14 Diabetic Foot Ulcerations

Case study review of a new gelling foam dressing in the management of 14 Diabetic Foot Ulcerations.
Introduction
Management of diabetic foot ulcers presents a major clinical challenge.
In 2007 a gelling foam dressing* was added to the wound care formulary at a district general teaching hospital in the UK. The aim of the review is to illustrate the effective use of the new gelling foam dressing* in the management of 14 diabetic foot ulcers.
Method.
Retrospectively 14 case notes were reviewed [12 male & 2 female; age 44-86yrs (mean age 65)] who had attended one of the podiatry ulcer clinics. Ulcer duration before dressings commenced 1 week – 12 weeks (mean duration 5 weeks).
Following holistic and local wound symptom assessment 14 ulcerations  were selected for use of the new gelling foam dressing.  
Wound symptoms included: peri-wound maceration, moderate to heavy exudate, clinical signs of infection and/or the presence of slough. Each ulcer was classified using Texas wound classification system (Armstrong et al 1998) and re dressed twice weekly.
A clinical decision was made to use an antimicrobial hydrofiber dressing** if clinical signs of infection were displayed.
Results.

Ulcer location.	Numbers	Texas Classification	Ulcer duration (wks) & referral source	Outcome - time to heal (wks)
Patients	14
Digit dorsal aspect or apex	III I I I	BI                                                B2                     DI                                                                D2	3/52 self treatment 4/52 GP 2/52 GP 5/52 nurses	7/52 20/52 12/52 32/52
Heel Ulcer	I                        I                        I	CI CI D2	8/52 nurses 10/52 nurses 7/52 GP	22/52 24/52 21/52
Interdigital ulcer	I                       I	DI D2	4/52 podiatry 4/52 podiatry	7/52 8/52
Plantar ulceration	I                       I                       I	BI AI B3	3/52 self treatment 4/52 podiatry 12/52 podiatry	died 7/52 3/52 (reulcerated)

Outcomes were positive: 12 of the 14 ulcerations remained healed. One patient re-ulcerated three weeks later and one patient died.
Discussion.
Although it is not possible to demonstrate this dressing regime alone led to the ulcerations healing, The application of a gelling foam dressing combined with an antimicrobial hydrofiber dressing when required, promoted positive and good clinical outcomes for these patients.
^®/TM The following are trade marks of ConvaTec Ltd
* Versiva® XC™
** Aquacel Ag®