A 69-year old woman presented with an ulcer of the ankle that had been present for 6 years. The wound had been treated with various regimens over the previous 6 years including compression therapy, hydrocolloids, alginates and silver-activated charcoal dressings.
The ulcer was 4.7 x 4.2 cm in size and 0.5 cm. It was heavily coated with fibrin. There was pronounced leg oedema, and the area directly surrounding the wound showed signs of infection.
Treatment Initially the ulcer was treated with TenderWet. After 8 days the wound had clearly improved. The fibrinous coating had partly scaled off, and clear islands of granulation tissue were visible. The wound was heavily discharging a serous exudate.
Treatment with PermaFoam dressing was commenced, with daily dressing changes.
Assessment After 2 days of PermaFoam Treatment granulation tissue had increased and there was no maceration at the wound edges. The interval between dressing changes was increased to 3 to 4 days. This Treatment was continued for 2 months.
On further Assessment the lower margin of the wound had closed, and the wound had deceased in size. There was an increase in granulation tissue and the fibrin islands were clearly reduced. A fragile epithelial border was visible at the wound margin.
After a further 2 weeks epithelialisation had increased sufficiently to allow a change in Treatment to Hydrocoll.
Conclusion After a further 6 weeks Treatment the wound was completely closed and entirely covered with an epithelial layer.
