URGOTUL DRESSING, SHOULD IT BE A TREATMENT OF FIRST CHOICE OR THE LAST RESORT? A CASE STUDY ANALYSIS
SHARON BUTLER, EDITH LARTEY, GILL CUTLER, MARTIN TADEJ
The recently published health economic analysis of the impact of chronic wounds on to the National Health Services (Guest et al, 2015) clearly demonstrates the magnitude of the problem. • Annual cost of treating chronic wounds in the UK in the years 2012-2013 is estimated to be between £4.5 billion and £5.3 billion and is comparable to the overall cost of managing obesity. • This case study is aiming to analyse an individual example of a journey taken by a single patient in order to have her leg ulcer healed. It will follow the decision pathways and some critical barriers preventing clinicians from achieving their treatment goals and will help to formulate thoughts for future clinical practice.
In May 2014, a female patient aged 46, was referred to the Thurrock Day Hospital (South Essex) with an existing leg ulcer for diagnosis and further treatment. She was already on a waiting list for the left hip replacement operation as she was also diagnosed with Osteoarthritis. • First ABPI assessment done in May 2014 confirmed good vascular supply to both lower limbs and a diagnosis of a Venous Leg Ulcer was made. Initially the leg ulcer was located on the right upper gaiter below the knee measuring 7.5x7.5 cm (Photo 1). • Although patient’s arterial status was monitored throughout the treatment period using Duplex Doppler Sonography. Ultrasound confirming Bi-Phasic and Tri-phasic waveforms, appropriate level of compression therapy could not be introduced due to extensive pain. This has resulted in the worsening of the overall condition of the leg ulcer and progressive further ulceration. • A plethora of wound care products were tried, but none was able neither to reduce pain and exudate levels nor to make any progression in the wound healing process. • By October 2015 the patient and the clinical team has exhausted all available treatment options. The patient, so desperate to have her leg ulcer healed, was waiting for the hip replacement operation giving her a glimpse of hope to return back to her normal life. • After 18 months of treatment with no success at sight the thought of not having a leg ulcer seemed inconceivable. However following educating teaching sessions with the Urgotul representative the clinical team were prepared to try Urgotul primarily due to its atraumatic removal. • Almost immediately the patient recognised the difference. But this time it was different altogether. Urgotul allowed a completely atraumatic pain free dressing removal. Gradually, nursing interventions were more decisive and radical. MIST therapy was stopped by advice of TVN. The patient described a soothing effect given by Urgotul. Single layer of Actico short stretch bandage was introduced which was gradually increased to the required two layer 40mmHg bandaging when pain was effectively controlled.
Since the introduction of the Urgotul dressing, pain levels gradually decreased. Morphine patches are still in use at a reduced dose with a view to gradually wean off. • Pain is now well controlled and she is able to tolerate washing of the leg and dressing change without any discomfort. Full compression therapy which was planned for this patient could be implemented and tolerated. • Rapid wound area reduction (WAR) has been observed. Inflammatory markers were not present throughout the duration of treatment with Urgotul. • Patient remains very happy, leaves the clinic with a smile and is able to drive her car.
Introduction of Urgotul has transformed the overall chances of healing of the venous leg ulcer for this patient. It has also made a significant positive impact on the overall wellbeing of this patient. Signs of depression have subsided, she regained the control over her own life back and her leg ulcers are significantly improved. • This atraumatic dressing has also allowed clinicians to use their time, skills and available resources more effectively. • Wound bed preparation process requiring using shower facilities, gentle mechanical debridement and full level of compression all have significant contribution, but were only introduced to this patient because the comfort levels were maintained and secured by Urgotul.
The unique patented Technology Lipido Colloid (TLC) in Urgotul has proven to be not only a completely atraumatic dressing and an excellent wound healing product. • More importantly its unique healing matrix technology has allowed the patient to regain confidence in clinical interventions and the clinical progress was made without compromising on this patients’ level of comfort. Its ability to remain in place under compression and maintain an optimum moist healing environment in the presence of low, moderate and high levels of exudate also meant stress free more manageable care planning for the nurses. • Every case in any way similar to the one presented in this paper should be subject for serious consideration of the treatment planning process. • If the patient comfort and normal wound healing are to be made a priority, Urgotul should be given consideration long before it should become a last resort solution.