Management of ulcers using advanced wound therapy: a small case series

Various treatment options exist for wound healing; however, evaluation of the wound environment and factors that impair wound healing need to be considered before selecting appropriate therapy. Here, we present a case series demonstrating successful wound closure using advanced wound treatments: collagen/oxidized regenerated cellulose/silver (C/ORC/S) dressings, negative pressure wound therapy (NPWT), and epidermal skin grafts harvested with an automated epidermal harvesting system. Patient 1 was a 28-year-old female who presented with a left knee pressure ulcer complicated by transverse myelitis, quadriplegia, poor nutrition, and diabetes. Following daily application of a debriding agent for 3 weeks, an epidermal skin graft was harvested and transferred to the recipient site using a non-adherent silicone dressing. At 1 week post-epidermal graft application, the wound healed and the patient was discharged. Patient 2 was a 63-year-old male, with a history of diabetes, ischemic stroke, and right-side paralysis, who presented with a left heel wound due to deep ulceration and emergency calcanectomy. Management consisted of 3 weeks of continuous NPWT at -150 mmHg and offloading. NPWT was discontinued, and C/ORC/S dressings were applied to the wound for 13 weeks. After sufficient granulation tissue formation, epidermal grafts were applied over the wound, which closed at 4 weeks post-epidermal graft application. Patient 3 was a 71-year-old female with mild dementia who presented with a sacral pressure ulcer as a result of prolonged toilet sitting. Treatment was initiated with daily application of a debriding agent for 3 weeks followed by 3 weeks of continuous NPWT at -150 mmHg. NPWT was discontinued and C/ORC/S dressings were applied three times a week. Wound closure was observed 12 weeks post-C/ORC/S application. In all three cases, adjunctive use of advanced wound care treatments positively affected the clinical outcome.