2 month old infected venous stasis ulcer

A 51-year-old gentleman had developed a venous stasis ulcer on the foot in the malleolus area. He was 6 ‘ 10” / 2.10 m tall and his work involved standing up for 10 consecutive hours daily. He would always wear compression stocking when at work. This would not be associated with a cardiovascular condition. On the same leg as the ulcer, he had an enlarged calf as an idiopathic condition, probably genetic. He had a 25 year history of varicose veins with surgery 20 years previously due to venous leg ulcers. Up until now, this had kept him free of vein problems.For the first 4 weeks the ulcer had been managed with standard plain dressings and the severe pain had been just manageable with codeine/paracetamol every 6 hours (this made the daily use of laxatives necessary). However, an infection developed. The patient was dressed with honey underneath full compression. The pain was reported to be excruciating and not controllable with the permitted maximum daily dose of codeine/paracetamol. As the ulcer had not improved after two weeks, the treatment was changed into iodine dressing under full compression. The pain level would increase even further and this forced the removal of the dressing after 3 days, i.e. 4 days prior to the planned dressing change. The ulcer was left for 6 days dressed with plain occlusive dressings. The pain reduced to the level of “excruciating pain”. As the infection and the pain were still uncontrolled, PHMB dressings under light compression were applied for 10 days during which the pain remained unchanged. After 10 days with PHMB, the infection was still not under control and Amicapsil was tried.

Amicapsil was applied on Day 0 and 1.

Day -7	Day 2
Day 23	Day 44	Day 90

 

24 hours after the first application, the infection had cleared and the pain was halved. This measure was based on the need of pain-killers being halved. Within the subsequent 24 hours the pain reduced again to the level that only 1 dose was needed in the morning (the use up till this point in time had been 1 dose every 6 hours and that would not control the pain). Over the next days the pain continued to reduce steadily and three weeks after first Amicapsil application, the patient would need no more pain killers.

As the infection was cleared after the second application, the wound started healing with no further need of treatment.

The wound was left with a permeable contact layer dressing kept in place by stockinette. It was checked and the described dressing changed after 3, then 5, then 7 days. After that, dressing changes were performed every other week and this was then extended to every 3 weeks.

On Day 90, the patient was discharged from the GP surgery as they did not consider their supervision necessary. The wound was 2 x 3 mm, non-infected and causing no pain.

Upon first presentation at the GP surgery, the patient had been told to expect between 6 and 9 months of weekly dressing changes with full compression. He had also been warned that full healing was questionable. Amicapsil had been able to resolve the infection after two applications, the pain level began to subside immediately and the patient was discharged after 3 months.

As the conditions of the vein causing the ulcer in the first place were too severe for the skin to be able to close fully over it, the patient was referred to a cardio-vascular surgeon for evaluation. After in-depth evaluations, these assumptions were confirmed and the patient was scheduled in for surgery as the venous condition was considered too severe to prevent and/or close future ulcers. The ulcer is expected to close fully following this procedure. As the ulcer and rest of leg was no longer infected, the surgery could be scheduled in without regards to this and the potential of ensuing complications was reduced.

One month after the first Amicapsil application the patient offered the following statement:

‘It’s not too much of an exaggeration to say Amicapsil changed my life. From 4 weeks of absolute hell, in pain 24 hours a day, struggling at work and looking at possibly taking time off to being pain-free, getting a full night’s sleep and back to normal at work.’