28 Jul Partnering with Vascular Surgeons Case Study
87 year old female with eight total venous ulcers to her bilateral lower extremities which had been present for 11 years.
Sharp debridement, UltraMIST®, 0.9% cadexomer iodine, absorptive dressings, multilayer compression, collaboration with vascular surgery, cellular and tissue-based products.
The patient is an 87 year old female with a total of eight venous ulcers to her bilateral lower extremities. Wound had been present for 11 years. Ulcers were associated with pain, odor, and copious exudate, requiring three dressing changes per day. Medical history of hypertension, A-fib, chronic kidney disease, and lymphedema. Previous treatment included care at a wound clinic. Patient was refusing to use compression due to copious drainage and inconvenience of multiple daily dressing changes.
left medial distal lower leg
Left posterior lower leg
management and outcome
The Mendota Health nurse practitioner performed weekly selective sharp debridement on the patient’s wounds. UltraMIST® was performed on the wounds, and they were dressed with 0.9 % cadexomer iodine and absorptive dressings, followed by standard multilayer compression.
At the start of care, the Mendota Health Nurse Practitioner recommended an arterial duplex to rule out arterial disease, but the patient was unwilling to have that test due to challenges with transportation. After 4 weeks, the wounds severely decompensated and were associated with a very poor peripheral vascular exam. At this time the Mendota Health nurse practitioner recommended that the patient go to the emergency department, but the patient refused to go for 1 week. Due to the persistence of the Mendota Health nurse practitioner, the patient finally presented to the emergency department, where the provider planned to discharge the patient home with antibiotics and without a vascular consult. It was only after communication with the Mendota Health nurse practitioner that the patient was admitted to the hospital, the vascular surgery consult was completed, and arterial disease was ruled out, but severe venous disease was diagnosed.
The patient had outpatient surgery on her leg veins, and the surgeon completed a transfer of care back to Mendota Health. At this time, the Mendota Health provider resumed the previous wound care plan, with the addition of cellular and tissue-based products when the wounds stalled, and the wounds began to respond.
This patient was healed in 13 months by Mendota Health, and she was finally relieved of her heavily draining wounds.
The patient reported that she gets to sit out on her porch and enjoy the sunshine. She said “I haven’t been out in months and now I can actually go out and walk around my yard!”.