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A case study by Wounds International outlining the clinical approach and successful management of a woman with rheumatoid arthritis who presented with a leg ulcer of 3 years’ duration.
27 May 2022
BySentry Medical
A complex patient with multiple disease states knocks at my door looking for solutions to a troubling medical issue. “Am I up to the task?” you may ask. “Can I help her attain a satisfactory outcome and improve her quality of life?” This case study outlines the clinical approach and successful management of a woman with rheumatoid arthritis who presented with a leg ulcer of 3 years’ duration.
The primary dressing used was Zorflex (imported by Sentry Medical), an activated carbon cloth dressing. This dressing is able to sequester and retain matrix metalloproteinases (MMP), including MMP-1, MMP-2, and MMP-9. Exudate in chronic wounds contains high levels of proteolytic enzymes, such as elastase from human polymorphonuclear granulocyte. Activated carbon cloth dressings reduce protease levels within a wound, are conductive, manage odor and bacterial load, and prevent increased microbial activity. The secondary dressing was a superabsorbent pad to manage the high level of exudate. The dressing was lightly taped with silicone fixation tape.
Short-stretch reusable compression therapy was applied to reduce edema and, over time, reduce exudate production. Lymphlex REDUCE (Sentry Medical) was chosen, which delivers sub-bandage pressures of 30-40mmHg at the ankle and at rest. The stretch of this product was modified on initiation of treatment to enable the patient to adjust, thereby allowing for optimal application over time.
The short-term goals of reducing the bacterial burden in the wound, reducing exudate and associated malodour, and decreasing edema and pain were achieved. Following this, consistent reduction in the size of the wound and continued improvement in the condition of the periwound skin lead to complete healing of this chronic leg ulcer.
As the patient’s symptoms and comfort improved, she became more engaged in her management and has continued to use compression stockings to prevent recurrence. She is now self-sufficient in the application and removal of her compression stockings with consistent support and help from her husband. The keys to successful healing in this case were the careful clinical evaluation and planning prior to the commencement of dressing, achieving results in a relatively short period of time. Involving the patient in treatment will reduce the risk of recurrence.
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