Unstageable pressure ulcer

Case contributed by: Catherine T. Milne, APRN, MSN, CWOCN, BC-ANP/CNS, Connecticut Nursing Associates, Bristol, CT.

Patient
89-year-old female with a history of Alzheimer's dementia, hypertension, coronary artery disease, congestive heart failure, chronic renal insufficiency, ABI of 0.87, and prealbumin of 15.8.

Wound presentation
Unstageable pressure ulcer resulting from the trauma of a fall which caused fractures to the left tibia and fibula. Patient was non-ambulatory with multiple comorbidities prior to the fall. Surgical intervention was deemed inadvisable, and the leg was placed in an immobilizer.

Treatment
The wound was irrigated with normal saline and then debrided with Collagenase SANTYL Ointment once daily or as needed if the dressing integrity was lost.

Pressure ulcer at baseline with over 85% non-viable tissue

 Individual results will vary.

DAY 1

  • » SANTYL Ointment initiated

  • » 8.82 cm x 6.64 cm (no depth)

  • » 85.6% non-viable tissue

  • » Scant serous drainage; no odor

  • » Unremarkable periwound

Pressure ulcer at day 14 with 76% wound area decrease from baseline and 69% non-viable tissue. Individual results will vary

DAY 14

  • » 4.85 cm x 2.86 cm (no depth)

  • » 76% wound area decrease from baseline

  • » 69.4% non-viable tissue

  • » Mild serous drainage; no odor

  • » Unremarkable periwound

Pressure ulcer at day 28 with 26% non-viable tissue. Individual results will vary

DAY 28

  • » 4.45 cm x 2.65 cm; 0.6 cm depth

  • » 26.2% non-viable tissue

  • » Residual necrotic tissue remaining

  • » Non-viable tendon

  • » Mild serosanguinous drainage; no odor

  • » Unremarkable periwound

Pressure ulcer with non-viable tendon at day 42 with 90% wound area decrease from baseline using effective debridement. Individual results will vary

 Individual results will vary.

DAY 42

  • » 3.75 cm x 1.50 cm; 0.50 cm depth

  • » 90% wound area decrease from baseline

  • » Some non-viable tendon remains

  • » Wound bed granulating;
    epithelialization from wound margins
    is well established

  • » Mild serosanguinous drainage; no odor

  • » Unremarkable periwound

  • » SANTYL Ointment discontinued

Results

Wound reached complete debridement by Day 42.


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.