1. REDUCING PAIN, ALLOWING COMPRESSION THERAPY

Summary

A patient with a venous leg ulcer could not tolerate any compression therapy because of pain scoring 10/10.

Therapy with Accel-Heal rapidly relieved the pain, allowing graduated compression therapy to be started. The wound healed three weeks after starting Accel-Heal therapy.

Before Accel-Heal

A 50-year-old patient with a history of recurring venous leg ulcers despite wearing compression hosiery, presented with a very painful ulcer of three-weeks duration. The patient had previously suffered from a fracture of the right ankle. Limb assessment confirmed advanced venous disease. The patient’s wound was excruciatingly painful with a pain score of 10/10 despite taking co-codamol and pregabalin.

The wound pain caused her to cry with the discomfort, particularly during dressing changes. Various topical cleansers, honey and absorbent dressings with support bandages had been applied. She had also had several courses of antibiotics.

Although graduated compression therapy was considered, the patient could not tolerate the therapy because of the wound pain. She also could not tolerate the assessment of ankle-brachial pressure index (ABPI), although all foot pulses were audible with tri-phasic and bi-phasic sounds.

During treatment with Accel-Heal

Accel-Heal was started in December 2016 – the aim was to relieve the pain sufficiently to measure ABPI and to enable the patient to wear graduated high compression bandaging. At the beginning of therapy, the wound measured approximately 7.5cm2 .

Along-side Accel-Heal, the wound was dressed with a topical honey dressing and highly absorbent secondary dressing and a support bandage. The peri-wound skin was protected with a barrier cream. During dressing changes, the wound was irrigated with anti-microbial irrigation fluid.

Three days after starting Accel-Heal therapy, the patient returned to the clinic for a scheduled dressing change. Her pain score was much reduced to 3/10. She reported sleeping better and was now able to tolerate dressing changes.

The pain continued to improve during therapy. The wound itself also significantly improved with a reduction in wound size and exudate. At the end of the 12-day therapy, the pain was minimal and only small dry scabs remained.

Results

At the end of the 12-day Accel-Heal therapy, graduated short stretch compression bandaging was applied. The aim was to continue short stretch bandaging until good tensile strength was obtained in the wound and then to measure for compression hosiery to prevent a recurrence. The wound was completely healed, and the patient was discharged with compression hosiery in February, around two months after Accel-Heal therapy.

The patient was so grateful for the ‘wonderful result’ and in particular she expressed the delight in achieving a ‘normal and pain-free Christmas’, which she had been very worried about. She was surprised by the speed of recovery and more importantly the reduction in pain being so significant within a few days of therapy

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