Watch Dr Sollecito Present the Treatment Plan for a Venous Leg Ulcer

In this treatment presentation, Dr Sollecito walks viewers through the treatment plan he employed in the case of a 75-year-old man with type 2 diabetes undergoing treatment for venous stasis ulcers of the left leg.

This video was sponsored by ConvaTec.

Transcription:

Hi. I'm Dr. Vince Sollecito. I've been in practice for 40 years in treating wound care. Thank you for your attention.

My treatment plan on this very difficult case was using the Wound Hygiene Protocol, which includes thorough wound cleansing, sharp debridement, and refashioning of the wound edges, which has been compromised by maceration, then applying AQUACEL® Ag Advantage, an antimicrobial hydrofiber dressing covered with ConvaMax, a super absorber.

For compression, we used a triple-layer Unna Boot, which was applied and changed 3 times a week. Our goal of the therapy was to have the wounds progress to a point at which they could fully heal with amnion/chorion grafting or split-thickness skin grafting. The patient was seen weekly or bi-weekly, depending on the weather.

The patient first presented in the winter. In St. Louis, this winter wasn't very nice, so we couldn't see him every week like we would like to. We did have home health continue the dressing changes, however, in our absence, 3 times a week. Over the course of the treatment, the patient's pain level was significantly decreased, which was one of the primary causes of him coming to us.

It should be noted that Vascular Surgery was about to amputate his leg because his insurance benefits were, essentially, lapsing because they had been treating him for 18 months. They were doing everything right. The wound drainage was decreased quite a bit. This was impressive because we saw no periwound inflammation, which was being treated prior to us with steroids.

We also noted new granulation tissue during the course of treatment, with epithelial islands, so that each visit this wound progressed. It should be noted that we started out with 510 square centimeters, which really was 529 square centimeters after the initial debridement that I did.

We wound up going down after 18 weeks of therapy to 101 square centimeters, which was an 81% decrease. I saw this patient yesterday. Because of the significant wound progress we made with our Wound Hygiene Protocol, we began our amnion grafting. We started this weekly and then evolved to bi-weekly.

The patient has been doing really, really well. His greatest comment to us was that he had his life back. His edema was decreased. He did not have pain. He did not have an odor. He was able to sleep in a bed without getting the bedsheets soiled. In my practice, venous ulcerations are some of the most difficult wounds to heal.

The venous insufficiency is usually profound. The edema, the excess of exudate, and bioburden have a profound effect on how these wounds heal. This case, to me, exemplifies the importance of a protocol that includes cleansing, debridement, and dressings that can manage the exudate and the bioburden which advances healing in hard-to-heal wounds.

In the following, you're going to see some images. To me, the measurement of these wounds is difficult. Pictures speak a thousand words.

Please give me your feedback.

Thank you.