Bilateral heel ulcers- A complex case for topical negative pressure wound therapy
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Publication: Wound Repair and Regeneration
Start Page: A56
Introduction: This case study illustrates the successful use of topical negative pressure wound therapy (TNPWT) in the treatment of bilateral heel pressure ulcers complicated by osteomyelitis. Case Study: Mr Boots was referred to the Diabetic Foot Unit at the Royal Melbourne Hospital in May 2007, following the development of bilateral stage 3 heel pressure ulcers during his current hospital admission. Medical history includes Type II diabetes mellitus with complications including ischaemic heart disease, peripheral vascular disease, neuropathy, retinopathy and nephropathy. On assessment the right and left heel wounds were virtually identical. The wounds measured approximately 40 Ã— 25 mm and were 95% necrotic. Wound swabs indicated infection of methicillin-resistant staphylococcus aureus (MRSA) and psuedomonos aeriginosa organisms. The calcaneal bone could be probed in the wound base and radiological imagining was positive for bilateral osteomyelitis. Doppler ultrasound revealed vascular compromise. Both wounds were surgically debrided of all necrotic tissue and TNPWT dressings applied until there was no remaining cavity. This took four weeks. On cessation of TNPWT the wounds were dressed with silver hydrofibre and absorbent pad. Pressure offloading was achieved throughout treatment with pressure reducing ankle-foot orthoses. Conclusion: TNPWT can appear as an overwhelming dressing choice to untrained clinicians, however, it needs to be utilised more frequently as the first line of wound management in cases such as this. In addition to the successful salvation of both lower limbs the wounds were able to heal without residual deformity. Wounds on the feet managed with other dressing regimes often heal with deformation that goes on to be a site of future tissue fragility and high risk of breakdown. The successful healing of a deep foot ulcer with anatomical shape preserved more than justifies the time and resources invested in healing of these wounds with TNPWT technology.