Authors (including presenting author) :
Ngan HL
Affiliation :
Stoma & Wound Care, Nursing Services Division, United Christian Hospital
Introduction :
Chronic venous insufficiency is one of the common causes of hard-to heal chronic leg ulcer. This case involves a 58- year-old retired postman with left calf ulceration persisting for over a year. He had medical history of hypertension, diabetes mellitus, osteoarthritis (OA) knee, obesity, and adjustment disorder. The patient was referred to general outpatient Wound Nurse Clinic (WNC) for wound management. Upon his initial visit, his wounds exhibited severe wound infection with necrotic slough, and surgical admission was recommended for wound debridement to prepare the wound bed. Post-discharge, compression therapy was initiated alongside advanced wound dressing in the WNC. Despite a year of treatment, while the wound size reduced, it remained static and non-progressive. Consequently, the patient was referred to a specialist outpatient WNC for advanced management.
Objectives :
This case study describes the intensive wound management approach used to enhance the healing of a chronic venous insufficiency leg ulcer.
Methodology :
The treatment approach in the specialist outpatient WNC involved the following steps:
1. Wound Bed Preparation:
- Assessment of wound tissue status to tailor treatment based on wound characteristics
- Management of wound infection and removal of non-viable tissue through debridement
2. Compression Therapy Modifications
- Transition from long-stretch to short-stretch compression bandages to encourage patient mobility and improving venous return
- Introduction of the intermittent pneumatic compression pumps to further enhance circulation and promote healing
3. Self-Adherence Compression Therapy
- In the later phase of treatment, the patient was switched to self-manipulable adherence-enhancing compression therapy to maintain circulation.
- This approach empowered the patient to take responsibility for long-term self-care and reducing the risk of ulcer recurrence.
Result & Outcome :
After 4 months of the treatment at the specialist outpatient WNC, the patient’s wound completely healed. Importantly, the patient did not experience any recurrence for 2 years following the completion of treatment. This case highlights the challenges of managing chronic venous insufficiency-induced leg ulceration and the need for a tailored, multifaceted approach, particularly when initial therapies yield limited progress. The availability of various compression therapy options allows healthcare providers to customize interventions based on individual patient needs. Additionally, this case also emphasizes the need for ongoing evaluation and adjustment of treatment strategies to achieve optimal outcomes.
