Patient:A 61-year-old female presented to the emergency department for evaluation of infected, bilateral lower extremity wounds. The patient had a prior medical history of ulcerative colitis and atrial fibrillation. Eighteen months prior, the patient recalled noticing a quarter-sized blister on her left lower leg following the removal of rain boots after being in her yard. Edema subsequently developed bilaterally to her lower legs in addition to rapidly progressing wounds. She was admitted to the hospital where she was prescribed antibiotics, and discharged home, which was followed by her commencing outpatient visits to a dermatologist. A diagnosis of pyoderma gangrenosum of the lower extremities stemmed from the clinical evaluation of the lower limbs along with her underlying comorbidity. Antibiotics yielded no change and were discontinued, and she transitioned to treatment with cortisone. The wounds demonstrated increased drainage and became malodorous. The patient underwent an evaluation by the clinician to determine the course of treatment.

Diagnosis:The patient had infected, bilateral lower extremity wounds resultant of a prior diagnosis of pyoderma gangrenosum. Following other modalities, the wounds were managed with V.A.C. VERAFLO™ Therapy using reticulated open cell foam dressings with through holes (V.A.C. VERAFLO CLEANSE CHOICE™ Dressing) to facilitate wound cleansing and promote tissue granulation.

Course of Treatment and Application of V.A.C. VERAFLO CLEANSE CHOICE™ Dressing:Prior to wound management with V.A.C. VERAFLO™ Therapy using V.A.C. VERAFLO CLEANSE CHOICE™ Dressing, the patient had received biological skin grafting to her lower extremity wounds and had undergone multiple rounds of debridement. On the day of presentation (Day 0), the bilateral leg wounds

CASE STUDY

Use of V.A.C. VERAFLO CLEANSE CHOICE™ Dressing to promote wound healing in an infected, bilateral lower extremity woundsAnna Marie Michel, RN; Bayfront Health, Punta Gorda, FL

Figure 1: Right lower extremity wound evaluation prior to collagenase ointment application. A. Anterior aspect of right leg wound on HD 1. B. Lateral aspect of right leg wound on HD 1. C. Medial aspect of right leg wound on HD 1.

Figure 2. Left lower extremity wound evaluation prior to collagenase ointment application. A. Lateral aspect of left leg wound on HD 1. B. Medial aspect of left leg wound on HD 1.

Figure 3. Lower extremity wounds post enzymatic debridement and prior to application of V.A.C. VERAFLO CLEANSE CHOICE™ Dressing. on HD 3. A. Anterior aspect of right leg prior to application of V.A.C. VERAFLO CLEANSE CHOICE™ Dressing. B. Lateral aspect of right leg prior to application of V.A.C. VERAFLO CLEANSE CHOICE™ Dressing. C. Medial aspect of left leg prior to application of V.A.C. VERAFLO CLEANSE CHOICE™ Dressing.

Photos and patient information courtesy of Anna Marie Michel, RN; Bayfront Health, Punta Gorda, FL.

NOTE: As with any case study, the results and outcomes should not be interpreted as a guarantee or warranty of similar results. Individual results may vary depending on the patient’s circumstances and condition.

NOTE: Specific indications, contraindications, warnings, precautions and safety information exist for KCI products and therapies. Please consult a healthcare provider and product instructions for use prior to application. Rx only.

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demonstrated moderate to heavy exudate and a foul odor. On hospital day 1 (HD 1), a surgeon and wound care nurse were consulted to evaluate the wounds (Figures 1 and 2). A medical consultant for infectious disease was also involved in the evaluation. Given her pyoderma gangrenosum diagnosis, the surgeon advised against surgical debridement. However, both legs underwent enzymatic debridement using a collagenase ointment (Santyl◊ Ointment; Smith & Nephew plc, London, UK) for two days (Figure 3). Wound care staff recommended enlisting V.A.C. VERAFLO™ Therapy using V.A.C. VERAFLO CLEANSE CHOICE™ Dressing to promote wound cleansing. On HD 3, V.A.C. VERAFLO CLEANSE CHOICE™ Dressings were applied to the bilateral leg wounds and V.A.C. VERAFLO™ Therapy was initiated. The wounds were instilled with normal saline with a dwell time of 10 minutes, followed by the application of -125mmHg of subatmospheric pressure for 1 hour. Each leg had its own negative pressure wound therapy unit (V.AC.ULTA™ Therapy Unit), and the legs remained separate to afford the patient safety while transferring to a bedside commode. As the patient received V.A.C. VERAFLO™ Therapy, she maintained good pain management, received intravenous antibiotics and cortisone treatment. After 3 days of wound cleansing with V.A.C. VERAFLO™ Therapy using V.A.C. VERAFLO CLEANSE CHOICE™ Dressing, the wounds were revaluated (Figures 4 and 5). The wounds attained their therapeutic goal of wound cleansing, and V.A.C. VERAFLO™ Therapy was discontinued (HD 6).

Follow-up and Discharge:After V.A.C. VERAFLO™ Therapy was discontinued, the bilateral leg wounds were wrapped with gauze bandage rolls saturated with a triple antibiotic (gentamicin-clindamycin-polymyxin) solution (GCP solution). The patient continued to be treated for Clostridium difficile as well as a rectovaginal fistula and bowel incontinence. The wounds were evaluated weekly and the infectious disease clinician managed the bilateral wounds until the patient was discharged on HD 34 (Figure 6).

Figure 4. Lower extremity wounds post removal of V.A.C. VERAFLO CLEANSE CHOICE™ Dressing. A. Anterior aspect of right leg wound on HD 6. B. Lateral aspect of right leg wound on HD 6. C. Medial aspect of right leg wound on HD 6.

Figure 5. Lower extremity wounds post removal of V.A.C. VERAFLO CLEANSE CHOICE™ Dressing. A. Lateral aspect of left leg wound on HD 6. B. Medial aspect of left leg wound on HD 6.

Figure 6. Bilateral lower extremity wounds following 4 weeks of treatment with gauze impregnated with GCP solution. A. Lateral aspect of right leg wound on HD 34. B. Posterolateral aspect of right leg wound on HD 34. C. Lateral aspect of left leg wound on HD 34.