Mrs DS is an 83-year-old widow who suffers from dementia but has a very supportive daughter. The patient gave consent for her daughter to explain how the ulceration affected her personally and the impact it had on their family unit.
Mrs DS is an elegant woman who takes great pride in her appearance and is also a private person. She enjoys spending time with those closest to her, her daughter and her family, taking part in family outings and going out for coffee and shopping. Her daughter is married, works full time and has a grown-up son and an 11-month-old granddaughter.
Mrs DS lives independently, but depends on support from her daughter. Her daughter described the effects of her mother’s ulceration as a “living nightmare” for both her mother and the family. Mrs DS found the physical symptoms of her condition distressing and extremely stressful. The pain disturbed Mrs DS’s sleep, as “even the weight of a sheet touching the leg causes extreme pain”.
The high levels of uncontrolled exudate also caused Mrs DS significant upset, with the exudate seeping through the dressings and often “into her shoes and staining her clothing”. Malodour from the ulcer, which the daughter described as “so bad that we have to open windows”, caused Mrs DS to become more withdrawn and abandon her regular trips out with her daughter. As a result, Mrs DS withdrew from family contact, becoming a “virtual recluse” and only allowing her daughter to visit regularly.
She was “extremely embarrassed by the smell” and “kept apologising” to her daughter. Mrs DS's daughter said: “People didn’t realise the impact that mum’s chronic wound had on my life. Due to the care that mum needed and all the appointments, it felt like my life wasn’t my own anymore. It all revolved around mum and I was trying to juggle all my responsibilities and felt unable to get on with my own life. It placed a huge strain on my marriage and at many times I felt like I couldn’t cope anymore. It was awful watching mum go through this hell with no improvement; sobbing in pain, being embarrassed by the smell from her wound and withdrawing from life; and not being in position to help her in any real way was truly awful. Her condition affected every aspect of our life as a family.”
Mrs DS attended her first appointment at the leg ulcer clinic on 17 September 2013 following a referral by her GP. She had a 2-year history of spontaneous ulceration in the gaiter region on her left leg which had remained unhealed and was her second episode of ulceration in 6 years. During this period, she underwent compression therapy but it was discontinued for reasons that remain unknown. Her wound bed was 100% slough with peri-wound oedema. Her ABPI was 0.92 and her pain was 7/10 on the VAS.
Due to the chronicity of the ulceration, treatment with Accel‑Heal® was discussed with the patient and her daughter and consent obtained. It was agreed that her daughter would be taught how to change the units every 48 hours. The main objectives for using Accel‑Heal® were to induce the healing process and reduce the pain.
Treatment and outcome
Accel‑Heal® treatment was commenced on 4 October 2013 for 12 days alongside her compression therapy. On commencement, the total wound area measured 10cm2 and there was a 100% sloughy wound bed.
On 8 October, the wound had reduced in size by 20% and granulation tissue had formed. Mrs DS reported reduced pain (4/10 on the VAS scale). By 11 October, the wound area was 30% smaller than at the start of treatment. The wound bed continued to develop granulation buds and decrease in size. Mrs DS’ pain score had reduced to 1–4/10.
On 15 October, the wound area had reduced in size by 40%, with epithelialisation tissue appearing. The pain score remained at 1–4/10 on the VAS. Treatment was completed on 16 October.
Post treatment, on 22 October, the wound area had decreased by 60% and her pain had reduced to 0–2/10. On 1 November, the wound had decreased in size by 90% and the pain had completely resolved. Full healing was achieved on 8 November which was within 5 weeks of beginning treatment with Accel‑Heal® .
During the Accel‑Heal® treatment, Mrs DS’ daughter stated: “It felt like we were witnessing a miracle. Mum’s pain diminished and within days we could see the wound getting smaller. The exudate got less and less and wasn’t smelly anymore and it was so nice to see Mum begin to enjoy life once again.