Authors (including presenting author) :
TO KY (1), Ngan HL (1)
Affiliation :
(1) Stoma and Wound Care, United Christian Hospital
Introduction :
Chronic venous leg ulcers are a common, and often difficult to treat. It causes significant disability and morbidity and also has a considerable impact on health care resources. Compression therapy is the gold standard treatment for venous leg ulcers, which uses bandages or stockings to provides external pressure on the ulcerous limbs. However, a stasis is always encountered in treatment progress.
Objectives :
Intermittent pneumatic pumping have been known for promoting fluid return in patients with venous insufficiency. The aim of the study was to share the experience and the effectiveness of applying Multi-layered bandaging together with Intermittent pneumatic pumping in a case with complicated venous ulcer wounds.
Methodology :
A 57-year-old man presented to a wound nurse clinic with multiple non-healing, large ulcers in his left leg for 3 months after a crash injury. He had the medical condition of morbid obesity, hypertension and poorly controlled diabetes mellitus (DM). He was then admitted to Ortho unit for large necrotic venous leg ulcer with repeated surgical debridement done.
In the first visit to the clinic after the debridement, the largest wound size was 9.0 x 12.0cm (L x W). Wound base was grossly reddish with heavy yellowish exudate. Ankle Brachial Pressure Index (ABPI) was measured at 1.14, long stretch below knee compression therapy was then started. Wound surface had 50% reduction after 8-week of regular treatment but then the progress remained static for half a year.
The combination of above knee multi-layered bandaging and IPC was then introduced to promote further wound healing. IPC provides on-off pressure to enhance fluid movement through the vein and to prevent venous hypertension. A sleeve wraps to the affected leg which is connected to a pump to inflate and deflate in a regular cycle. A 20-minutes pumping cycle was given followed by the above knee multi-layered bandaging for 2 times per week.
Result & Outcome :
After the application of the above treatments for 6 weeks, wound size was significantly reduced from 3.0 x 6.7cm to 0.6 x 1.0cm (L x W) while with 100% granulation tissue. Finally, the wound healed up in 10 weeks of the treatment provided.
In the maintenance, FarrowWrap garment, a simplified and intuitive design of compression devices which allow patient self-application, was applied to replace the mutli-layered bandaging to maintain pressure level to the limb with venous insufficiency.
