[Case report about the combined use of 2 moist wound dressings in the treatment of a chronic diabetic foot ulcer].
BACKGROUND
Approximately 4.5% of the Spanish population suffer from Diabetes Mellitus (that means around 1.8 million people). Currently, the main problem that diabetes treatment presents is controlling its chronic complications, being the diabetic foot one of them, which can end up causing an amputation. Prevalence of ulceration varies according to sex, age and population characteristics, oscillating between 2.4% and 5.6%. In Catalonia, in a community case study, the prevalence was of 7.9%. In the same way, it has been calculated that at least 15% of diabetics will suffer from foot ulcerations during their lives.


METHODS
A clinical case regarding a diabetic neuropathic chronic ulcer highly exuding was made to analyze the effect of this new dressing in the daily clinical practice. CombiDERM is an absorbent dressing with an external polyurethane plate and a central part with absorbent hydroparticles, indicated for the management of the exudate and the protection of the surrounding skin. 64-year-old woman, who suffered from Diabetes Mellitus type I to 28 years evolution with Retinopathy grade II, Artropathy of Charcott and a neuropathic ulcer of 4 years evolution. She was admitted in the Vascular Surgery Service the 6th of May of 1995 presenting an ulcer with signs of local infection in the sole of her left foot. Different local treatments were established and improvement periods were alternated with non-improvement periods, giving as a result an unfavorable evolution of the wound. The treatment with CombiDERM was established, using AQUACEL Ribbon (Hydrofiber dressing) as filling material. To evaluate the continuation of the treatment photos and acetates were taken, and data was registered in a Case Report Form.


RESULTS
At the beginning the ulcer presented a high level of exudate, no signs of infection, light pain and the skin surrounding the ulcer was lightly macerated. After nine days of treatment an improvement of the ulcer could be observed, with the presence of granulating tissue. On the twenty-fourth day, granulation in the bed of the wound was completed and the quantity of exudate had reduced significantly. Application and removal of the dressing was easy and without pain. The evolution of the lesion was very good, without signs of infection, and with a graded epithelization until the ulcer was completely healed, at the eleventh week of the treatment with the new dressing. (The surface of the ulcer decreased from 557.67 mm2 to 0 mm2).


CONCLUSIONS
Having in mind the good evolution of this ulcer and the characteristics of CombiDERM, the new dressing is an optimal alternative in the treatment of highly exuding diabetic neuropathy ulcers.
Hospital Universitario de Valme, Sevilla.
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Roselló Ruiz
D017719:Diabetic Foot / Q000451:nursing* / Q000503:physiopathology; D005122:Exudates and Transudates; D005260:Female; D006801:Humans; D006813:Humidity; D008875:Middle Aged; D009779:Occlusive Dressings / Q000592:standards*; D014945:Wound Healing