Limitations
One limitation of this study was the small number of cases. These 2 cases were challenging because the VLUs were large (91.4 cm and 50 cm); chronic (16.8 months and 19.2 months); had not responded to many types of dressings and treatments; and both patients had refused surgical debridement due to the pain of the procedure. Wound healing of the first patient's ulcers was further complicated by her medications, including prednisone and immunosuppressive medication for her renal transplant.
A second limitation of this study was the short duration of 3 weeks. However, within 3 weeks of initiating SAWD, the wound bed of both cases appeared to undergo significant improvement. The rapid transition from slough to granulation tissue bed suggests the SAWD provides the appropriate wound environment for rapid autolytic debridement.
Case 1 utilized SAWDs for 3 months for wound closure. Subsequently, a bioengineered skin substitute (Apligraf, Organogenesis, Canton MA) was applied to both of the patients' ulcers and covered with SAWDs. At 9 months and 8 days, the top VLU of Case 1 had completely healed, and the large VLU had almost healed as shown in Figure 3. The patient's pain level had declined by 90% after 5 months of treatment. Case 2 was treated with SAWDs for 2 months and then the patient was lost to follow-up. During the 2 months of treatment with SAWD the ulcer base transitioned to a fully granular base with complete absence of slough and healthy margins.
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Figure 3.
Case 1, 9 months, 8 days from presentation. This ulcer was treated with the application of self-adaptive wound dressings and compression wraps for 3 months, and then a bioengineered skin substitute was applied. Selfadaptive wound dressings continued to be applied over the skin substitute.