Mrs SB is a 57-year-old lady who is married with three children and works full time as a children and families social worker. She is usually an active member of her church community and likes to socialise with her family and friends.
Mrs SB reported the effects of living with her ulceration as “utterly debilitating” and “the most stressful experience of my life”. She described her overall quality of life as “the worst possible” due to the physical symptoms that affected her daily life. Mrs SB experienced constant pain that prevented her from sleeping and that she described as “much worse than labour pains because it hurt just as much but unlike labour pains was constant”.
She reported feeling extremely anxious and stressed, as she was unable to work because of the pain and the side effects of the analgesia, which made her feel very drowsy. As a result of the ulceration, she was unable to attend her regular church services or get involved in her usual social activities. She found this “deeply upsetting” as she felt removed from her church community, which she described as her “support circle outside the family”. The ulceration also impacted on her ability to perform her activities of daily living and she had to rely on her husband for assistance, which made her feel a “burden” to him.
Assessment and treatment prior to commencing treatment with Accel‑Heal®
Mrs SB presented to the Leg Ulcer Clinic with spontaneous right lateral malleolus ulceration of 3 weeks’ duration. The wound bed was 100% sloughy, shallow with macerated edges, and malodorous, with erythema to the periwound skin. Her ABPI was 0.88 and her pain was 10/10 on the Visual Analogue Scale (VAS).
Following antibiotic therapy and 3 weeks of full compression therapy, the ulcer failed to progress and increased in size to 12.2 cm2. The possibility of using Accel‑Heal® was discussed with Mrs SB and a decision was made to commence the treatment with the objective of reducing the pain and inflammation.
Treatment and outcome
Accel‑Heal® treatment was commenced on 8 April 2014 (Figure 1) for 12 days alongside her compression therapy. Mrs SB was trained to independently change the device every 48 hours.
On 11 April, significant improvement was noted with the wound bed debriding (Figure 2) and Mrs SB’s pain score had reduced to a VAS score of 6/10. By 17 April, granulation buds were developing and the inflammation was reducing.
Accel‑Heal® treatment was completed on 20 April (Figure 3), and by this date the wound bed had undergone significant changes, with the development of further granulation buds and reduced exudate. Mrs SB reported a further reduction in pain at this time, having a VAS score of 0–4/10. The wound continued to reduce in size and tramadol was discontinued.
On 29 April, Mrs SB was able to return to work on reduced hours. Full healing was achieved on the 20 June 2014 (Figure 4). For an overview of her treatment, see Table 1. During the Accel‑Heal® treatment, Mrs SB reported that “the pain started to get less and less and I could see the wound healing, which was wonderful”. When her ulcer had healed completely, she said: “I feel that I now have my life back and can function normally without being a burden on my family,” and “I am delighted because I am no longer in pain” and “not having to take lots of medication”.