Case Closed: Effective Treatment for a Complicated Lower Limb Ulcer

Lower-extremity ulceration is a debilitating condition affecting up to 5% of patients >65 years old.¹ Every year, significant resources are spent to treat, prevent, or decelerate the progression of lower limb ulcers. Research related to causes and treatment of lower limb ulcers is prompted by their recurrent nature, the ineffectiveness of treatments, and the associated high costs of health care services.² Regardless of the cause, early intervention and treatment result in better outcomes for patients.³

The unique properties of the RTD® Wound Dressing (Keneric Healthcare, Irving, TX) provide an excellent care option to effectively and quickly heal lower limb ulcerations. The RTD® Wound Dressing is a highly absorbent, ready-to-use polyurethane foam dressing available in ¼-inch and 1/8-inch thickness. It is the only dressing on the market that contains 2 known organic active ingredients integrated into the polymer matrix — methylene blue (0.25 mg/g) and gentian violet (0.25 mg/g) — plus a silver compound (silver zirconium phosphate [7 mg/g]). This dressing provides sustained antimicrobial protection and is effective against a broad spectrum of Gram-negative and Gram-positive bacteria, yeast, and fungi. The 3 active ingredients, including silver, provide combined antimicrobial properties that have demonstrated effectiveness with common wound pathogens such as Staphylococcus aureus, methicillin-resistant S. aureus (MRSA), Escherichia coli, Pseudomonas aeruginosa, and Bacillus subtilis.⁴ In addition, this dressing is hydrophilic and features absorptive properties that create an optimal environment for wound healing.

The following case study presents a cost-effective and beneficial treatment for lower limb ulcerations using RTD® Wound Dressing.

Case report. An 82-year-old man presented with an ulcer of the anterior right leg that had appeared 1 month prior. The wound tested positive for Enterococcus. The patient has a history of lower limb ulcerations, venous insufficiency, type 2 diabetes, and congestive heart failure (CHF); he was in and out of the hospital for his CHF while this wound was being treated.

The initial treatment regimen for this patient included TheraHoney Gauze (Medline Inc, Mundelein, IL) and Adaptic (Systagenix, San Antonio, TX) changed 1 time per week for 12 weeks (see Figure 1). Treatment continued for an additional 3 weeks utilizing Drawtex (SteadMed Medical, Fort Worth, TX), which was changed weekly. The patient was treated for an additional 4 weeks with povidone-iodine and gauze, changed weekly (see Figure 2). At the conclusion of 19 weeks of treatment, the wound had increased in surface area by 0.4 cm x 0.9 cm x 0.1 cm. Beginning June 6, 2014, the wound was treated once a week using RTD® under a compression wrap (see Figure 3). This complicated wound was effectively resolved 13 weeks later (see Figure 4). In addition, the patient reported less pain following the use of RTD®, likely due to the dressing’s gentian violet, which is known to reduce wound pain and size.⁵

Conclusion

The RTD® Wound Dressing provides an effective option for treating lower limb ulcerations. In this case, the wound resolved in 13 weeks after alternative treatment options provided no improvement. Ultimately, a quicker healing time for lower limb ulcers could help save staff time and money. 

Case Closed is made possible through the support of Keneric Healthcare, Irving, TX. The opinions and statements provided in Case Closed are specific to the respective authors and not necessarily those of Ostomy Wound Management or HMP Communications. This article was not subject to the Ostomy Wound Management peer-review process.