A 43-year-old male patient was admitted to hospital with a two week old gun bullet wound complicated with inflammatory colonisation and infiltration of the anterior abdominal wall.
Upon examination, an infiltration 11.0 х 6.5 cm in the left iliac area was identified. In the infiltration centre there was a bullet hole 1.5 х 0.7 cm leading into a 3.5 cm deep tunnel. The tissue surrounding the hole and the tunnel was necrotized, inflamed, oedematous and of a dark colour. A bullet was found at the bottom of the wound tunnel.
The bullet was surgically removed and surgical debridement was performed.
During the following week, the wound would be dressed with iodine based dressings and the patient would receive systemic antibiotics and anti-inflammatory analgesics.
The performed treatment showed no substantial effect. The degree of colonisation and infiltration remained unchanged and no evidence of wound healing was observed. The patient rejected outright the proposed surgical excision of the colonised and infiltrated area.
It was decided to apply Amicapsil to the wound and the entire tunnel after brief chemical debridement with 3% hydrogen peroxide. Amicapsil was applied for 2 consecutive days and during this period the wound tunnel was cleared completely of slough started granulating. Over the following 7 - 8 days the broad peri-wound colonisation and infiltration reduced significantly to 3.0 x 2.5 cm, the tunnel granulated from the bottom up to surface level and the wound started epithelialising.
Within 14 days of the first Amicapsil application, the wound was fully healed and the peri-wound infiltration had resolved. The patient was seen one month later and only a superficial scar of 1.0 х 0.4 cm was found. The patient experienced no discomfort.