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Hydrotherapy wound healing of a category 4 pressure ulcer

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HydroTherapy wound healing of a category 4 pressure ulcer to the heel

Diane Knowles1, Lisa Wright1 & Elaine Ricci2

Background: A 73 year old female patient and type 2 diabetes and multiple co-morbidities including neuropathy, chronic kidney disease stage 3, chronic obstructive pulmonary disease, and treated osteomyelitis to the right calcaneus.


Wound History: The wound presented as a non-infected chronic long-standing category 4 pressure ulcer (present for several months before her referral to podiatry) positioned over the right calcaneus. There was exposed, damaged bone from a previously-treated osteomyelitis in the wound bed. The wound (6.8 x 5.0 x 1.0 cm) was covered with an area of approximately 90% dense slough with the remaining 10% being bony tissue (Figure 1). Wound exudate level was moderate and there was macerated peri-wound skin. There was no clinical signs or symptoms of infection. The wound had previously been treated by with a succession of different debridement methods including autolytic and larvae therapy.


Treatment with HydroTherapy: HydroClean® plus 4 x 4 cm was applied and secured with Hypafix and a dressing pad as a secondary dressing. Pressure relief was maximised with an IPOS heel-relieving sandal and a wheelchair. To offload the heel wound in bed an inflatable wedge was used. The wound was dressed sequentially with HydroClean® plus with the aim of de-slough aiding wound bed preparation (Figures 2 and 3). Following a short period of time in hospital due pneumonia, the wound was deemed suitable for treatment with HydroTac® Concave with the aim of stimulating granulation tissue formation (Figure 4).

Conclusion: This wound presented with adherent slough that had been present for several months. HydroClean® plus was used to de-slough, remove devitalised tissue and aid in the preparation of a clean wound bed. HydroTac® was then used to aid in epithelialisation and promotion of healing. 

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