An elderly patient with a history of venous leg ulcers presented with two ulcers of 7 weeks duration.
One wound healed within four weeks and considerable improvement was noted
to the second wound which went on to completely heal within 38-weeks following issues with varicose eczema.
An 80-year old patient with a history of venous leg ulcers in 2007 and 2012 presented with two recurring ulcers on the left inner side of the ankle, extending extensively to the back of the ankle
and back of the leg. The ulcers had been present for seven weeks and had developed spontaneously, despite wearing class 2 compression hosiery. Limb assessment identified signs of venous disease.
Wound pain was scored 5/10 despite taking regular analgesia. The patient was reluctant to increase up the analgesic ladder and alternative means of relieving pain were considered.
Antibiotics had been prescribed following a positive wound swab. The wound was dressed two-to-three times weekly, with antimicrobial cleansing and debridement during dressing changes. Graduated reduced compression bandages (approximately 20 mmHg at the ankle) were used between dressing changes but high compression therapy was not tolerated.
During treatment with Accel-Heal
The 12-day Accel-Heal therapy started in March. The aims of therapy were to reduce the inflammation, pain and exudate and expedite healing.
Instructions were provided to the patient’s wife to change the Accel-Heal device every 48-hours and the dressing regime continued three times weekly when the nursing team changed the electrode pads.
Due to the extensive size of the wounds, the two electrode pads were applied at opposite sides of the wound/s, avoiding the risk of exudate saturating the wound due to leg dependency. Standard therapy with graduated reduced compression continued during and after the Accel-Heal therapy.
Figure 1. Left medial aspect 25:02:16
Figure 2 Left posterior aspect 25:02:16
Figure 3. Left medial aspect on 07:04:16
Figure 4. Left medial aspect 12:01:17. Wounds healed
During April, a great improvement was noted; exudate was decreased and the pain score reduced to 4/10 with no pain by the end of April.
One wound became infected and required two further courses of antibiotics between April and June, but the wound did not deteriorate. The patient could now tolerate graduated high compression therapy.
The patient developed marked varicose eczema and was prescribed an intensive course of topical steroids and emollients. The eczema and wounds were completely healed in December.
The patient was so delighted with the outcome he wrote a lovely letter – he could not believe the result when previous ulcers had taken so long to improve. He stated he had a huge improvement to his quality of life with no pain and no wet leaking legs.