Traumatic right lower leg ulcer

Patient
54-year-old male with no significant peripheral arterial disease who appears healthy after blood workup.

Wound presentation
A traumatic right lower leg ulcer (anterior medial aspect) in the setting of mild venous insufficiency. The wound was presumptively treated as pyoderma gangrenosum due to reported classic pattern of pathergy (increased size in response to trauma as well as clinical features).

Treatment
Collagenase SANTYL Ointment was applied within the wound, including on the wound edges, once daily for two weeks. Compression was accomplished with Tubigrip™ and Setopress™ wrap.

Lower-leg ulcer at baseline

 Individual results will vary.

DAY 1

  • » SANTYL Ointment initiated

  • » 3.2 cm x 2.0 cm (no depth)

  • » Adherent, dry, necrotic eschar covered wound

  • » Some gapping along the periphery

  • » No obvious purulence or fluctuance upon wound compression

Lower-leg ulcer at day 17 (top surface of plug) granular base and moderate serous drainage. Individual results will vary

DAY 17 TOP SURFACE OF PLUG

  • » 4.0 cm x 3.0 cm; 0.5 cm depth

  • » Granular base and moderate serous drainage

  • » Skin edges were violaceous and rolled with undermining on the superior margin

  • » Cap of necrosis gently excised without tissue trauma, revealing healthy, granular wound bed

Lower-leg ulcer at day 17 (bottom surface of plug). Individual results will vary

DAY 17 BOTTOM SURFACE OF PLUG

  • » No cellulitis, exposed bone, or purulent damage

  • » SANTYL Ointment held in favor of Restore™ contact layer and Aquacel™ Ag to address pain with dressing removed and persistent moderate serous drainage (respectively)*

* Do not use dressings containing silver (Ag) with SANTYL Ointment, as these ions inactivate collagenase, the active enzyme in SANTYL Ointment.

Results

Two weeks' follow-up showed full debridement. The underside of necrotic plug clearly demonstrated delineation of nonviable vs viable tissue (in wound base).

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Collagenase SANTYL Ointment is indicated for debriding chronic dermal ulcers and severely burned areas.

Occasional slight transient erythema has been noted in surrounding tissue when applied outside the wound. One case of systemic hypersensitivity has been reported after 1 year of treatment with collagenase and cortisone. Use of Collagenase SANTYL Ointment should be terminated when debridement is complete and granulation tissue is well established.

For more details, please see complete prescribing information.