Prevention of bilateral amputation in a non-concordant patient

As chronic wounds, venous leg ulcers (VLUs) are costly and impact significantly on a patient's quality of life. This case study focuses on the key considerations for wound management of bilateral venous leg ulcers in a 45-year-old mother who had undergone multiple admissions with sepsis secondary to the ulcers and whose life was considered at risk. The primary concern was to stabilise the patient, and then to determine the aetiology of the leg ulcers and develop a treatment plan. Kerraboot (Crawford Healthcare) was chosen to dress the wound initially as it is relatively quick and easy to apply while being atraumatic, manages exudate and facilitates autolytic debridement (Harvey, 2006). After 12 days debridement was complete and granulation tissue was observed to the skin surface level. At this time, the patient's condition had stabilised and the wound aetiology could then be determined. The ulcers were confirmed as venous and were subsequently managed with compression bandaging. They continued to heal, reducing in size by 60% after a further 3 months. By agreeing a highly individualised wound treatment plan with the patient that was tailored to both her needs and those of the wound, and by continually reviewing and revising this plan, bilateral amputation was avoided in this previously non-concordant patient.