Unique Solution for Infected Lower Extremity Wounds with Extensive Tendon and Bone Involvement

Problem:  An elderly diabetic woman came after three months of suffering from foot abscesses with destroyed joints and exudate deep in her sole. A 67-year-old woman with poor venous return from a knee deformity developed painful 9.0cmx4.5cm and 7.5cmx4.5cm foul-smelling abscesses with extensive tunneling beginning along her Achilles tendon, which was deteriorating with dried brown areas. A middle-aged man with Hansen’s disease had dorsal foot ulcers, including a heavily exudating 10.5cmx4cmx2cm wound with fully exposed tendons. Prior to coming to our remote clinic, these patients had no wound treatment other than keeping off flies with tied cloths.

Rationale:  Components in polymeric membrane dressings (PMDs) draw and concentrate the body’s natural healing substances into the wound bed to promote rapid healing while loosening bonds between slough and the wound bed, atraumatically pulling the slough and excess exudate into the PMDs. The hydrophyllic foam and glycerin in PMDs helps moisturize structures such as tendon and bone.

Methodology:  Treatment included oral antimicrobials, acetaminophen, prayer, nutritional counseling, and direct wound care. Initially, all wounds were sharply debrided and cleansed with saline or EUSOL. PMD filler was inserted into cavities and tunnels so all wounded surfaces contacted the dressing material. Exposed filler was covered with standard PMDs.  Dressings were changed daily or every-other-day, with frequency decreasing as wound healing progressed. All three patients remained ambulatory throughout treatment.

Results: Exposed tendons and bones stayed moist and viable, allowing retention of full foot mobility. The diabetic woman’s wounds closed in 8 weeks. The Hansen’s’ sufferer experienced wound closure in 38 days. Even the woman with poor venous return received quick wound healing: slough was completely cleared in 3 weeks and all of her wounds were closed within four months.

Conclusion:  PMDs kept these extensive lower extremity wounds with exposed structures clean and moist, supporting consistent, rapid healing.