ACTICOAT◊ 7 (with SILCRYST(TM) Nanocrystals) and the management of diabetic neuropathic foot ulceration
Introduction
This case study illustrates the use of ACTICOAT◊ 7 in the management of neuropathic foot ulceration to prepare the wound bed for healing.
Patient
The patient was a 46 year old male with a long history of insulin-dependent diabetes. Glycaemic control had been variable over the years, and there was evidence of peripheral sensory neuropathy affecting both limbs.
Between 1992 and 2000, the patient suffered at least six episodes of diabetic ulceration of the feet, one of which was severe enough to lead to amputation of the 4th toe on the left foot.
A second amputation procedure was carried out in 2000 following a period of ulceration and severe infection on the left 5th metatarsal head area. The 5th toe and the metatarsal head were amputated resulting in a large deep granulating wound. This wound was skin grafted with excellent results and healing was achieved in 4 weeks.
However, in April 2001 the patient became concerned regarding infection around the area of the previous skin graft site. The wound was malodorous with a moderate amount of discharge (see Fig. 1).
Treatment
In January 2002 the wound was sharp debrided, dressed with moistened ACTICOAT◊ 7, covered with a polyurethane foam and pressure relief was achieved using crutches. Glycaemic control was monitored and the patient was reviewed weekly.
At each review the patient was carefully monitored for signs of cellulitis and infection of the limb before redressing the wound.
Outcome
One month later the wound was found to be clinically free of infection. There was minimal discharge and the wound was odor free. The wound was almost closed with some residual unevenness around the area of the graft (see Fig. 2). Hospital admission had been avoided.
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| Fig 1 | Fig 2 |
Cost Analysis
The patient had approximately 12 months of conventional treatment for his diabetic foot ulcer, with the ulcer remaining unhealed.
A 4-piece course of ACTICOAT◊ 7 resulted in an ulcer that was reduced in size by 93% within 4 weeks.
| Pound Sterling (£) | US Dollars ($) | ||
| Cost of previous treatment |
Cost to heal with ACTICOAT◊ 7 | Cost of previous treatment |
Cost to heal with ACTICOAT◊ 7 |
| £11,960 | £920^ + £45 | $21,911 | $1685^ + $82 |
| Additional cost to reduce ulcer size by 93%: | £45 | Additional cost to reduce ulcer size by 93%: |
$82 |
This cost for treatment visits and conventional wound management products would have been incurred irrespective of treatment choice.
™SILCRYST is a trademark of NUCRYST Pharmaceuticals Corp, used under license.