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THE USE OF AQUACEL®Ag+ EXTRA™ DRESSING IN THE TREATMENT OF A COMPLEX LEG ULCER WITH SUSPECTED BIOFILM

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Genetic Peripheral Sensory Neuropathy is a debilitating sensorimotor neurologic disease with broad impact on activities of daily living and quality of life1. Ulcers and amputations are common and particularly prevalent in men, most commonly developing in the second and third decades of life1, 2. Loss of sensation can lead to painless injuries, which, if unrecognised, result in slow wound healing and subsequent osteomyelitis requiring distal amputations3.

At least 60% of chronic wounds are thought to have an established biofilm4. Biofilms are understood to delay wound healing and increase costs in appointment times, wound dressings and hospital

admissions1. Mr Z is a 69 year old gentleman with hereditary sensory peripheral neuropathy and an extensive medical history; Mr Z was referred to clinic by community nurses with two non-healing wounds to his left lower leg. Following full assessment compression therapy was recommended. Ankle Brachial Pressure Index was 0.95 with biphasic sounds. Unfortunately due to a previous poor experience with compression bandaging, Mr Z was not willing to have this commenced. Visual signs within the wound which made the clinician suspect biofilm included; a persistent low grade inflammatory state, high exudate and a shiny appearance to the wound bed. Treatment with AQUACEL® Ag+ Extra™ dressing was initiated to manage and treat biofilm and to progress the wounds towards healing.

Mr Z had good previous experience of AQUACEL® Extra™ dressing so he was amenable to having AQUACEL® Ag+ Extra™ dressing applied. This dressing provided good exudate management, components to break down biofilm and antimicrobial to effectively kill bacteria2,3.  Initially the wound required dressing three times per week with AQUACEL® Ag+ Extra™ dressing  (one of these was undertaken by the patients wife) until the patient was confident to reduce changes to twice weekly. At 12 weeks the wound showed clear signs of improvement and dressing changes were reduced to twice weekly; there was a reduction in the size of the wound and exudate levels decreased. 11 months later the wound was showing sign of epithelialising.

After more than 20 years of leg ulcers Mr Z was not immediately open to discuss which dressing and emollients suited his wound/skin. Mutual trust had to be established with clinicians, Mr Z, and his wife, and the management plan negotiated and agreed. He agreed to have AQUACEL® Ag+ Extra™ dressing as he had previously used AQUACEL® Extra™ dressing and had confidence in this product. Although the wound was slow to progress Mr Z reported he considered he was very slow to respond to any treatment and he felt his progress with AQUACEL® Ag+ Extra™ was considerably quicker than usual and was delighted with his result. 

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