Case study: Bulla of unknown etiology

Wound type:

Bulla

Patient

82-year-old male

History

Past medical history includes Type 2 diabetes, hypertension, congestive heart failure, dyslipidemia and asthma.

Full debridement of the wound in 16 weeks*
*Individual results will vary

Wound presentation

  • Presented to the hospital with pneumonia and sepsis. During exam, a large, dark, fluid-filled bulla on the dorsum of his left foot was located
  • A vascular workup revealed mild PAD (no intervention done)
  • Fluid was evacuated at bedside with a #11 scalpel following povidone iodine prep
  • It was dressed with a petroleum dressing gauze and secured with roll-gauze
  • The cultures of the bulla fluid were unremarkable
  • The patient was discharged from the hospital with instructions for wound center follow-up in seven–10 days
  • The patient followed up six weeks later

Treatment

  • Sharp debridement and 126 days of treatment were initiated
  • 112 days were physician-prescribed SANTYL◊ Ointment only with moist gauze
  • 14 days were patient-initiated medicinal honey only
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Baseline

Day 1: Baseline

  • Six weeks post-hospital discharge
  • Wound measures 11.2cm x 8.2cm
  • Skin grafting recommended; patient declined
  • Wound cross-hatched
  • Daily SANTYL Ointment initiated per manufacturer’s protocol with petroleum gauze dressing secured with roll-gauze
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Day 49

Day 49

  • Wound measures 10.2cm x 6.7cm
  • No sharp debridement performed
  • Daily SANTYL Ointment recommended for continuation but patient declined continued treatment
  • Patient initiates over-the-counter medicinal honey
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Day 63

Day 63

  • Patient returns to wound clinic after two weeks of OTC medicinal honey
  • Wound measures 9.7cm x 6.1cm
  • Decline in progress measured by marked and visible re-accumulation of fibrin & slough
  • No sharp debridement performed
  • Daily SANTYL Ointment with petroleum gauze dressing restarted
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Day 105

Day 105

  • Wound measures 6.5cm x 3.6cm
  • No sharp debridement performed
  • Daily SANTYL Ointment with petroleum gauze dressing continued to be applied on entire open wound bed
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Day 126

Day 126

  • Wound measures 4.0cm x 2.3cm
  • No sharp debridement performed; wound fully debrided
  • Daily SANTYL Ointment discontinued
  • Hydrogel application and gauze dressing initiated

Result

Full debridement of the wound in 16 weeks*
*Individual results will vary

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