The use of Actilite on severe bilateral leg ulcers
Brian Sankey - Tissue Viability Link Nurse, Ashby Care Home Lincoln (Lace housing Ltd.)
Mrs. K aged 76, was admitted to our Nursing home with severe bilateral leg ulcers with a 4 year history. She also has a history of Angina, P.E, on Warfarin.
She had been nursed at home by the district nurses. However she was self neglecting at home resulting in her falling and fracturing her hip so could not manage at home. Her diet improved on admission due to the holistic care package we operate.
Prior to treatment with Actilite honey dressing
On admission Mrs. K had a large amount of exudates from both legs, they were both swabbed which came back as mixed infection that would probably be susceptible to Iodine.
Unfortunately as this lady is on Warfarin the use of Iodine is not recommended. She is nursed on an airflow replacement mattress. She is not compliant with the Physiotherapists exercise routine and will not stay in bed or elevate her feet for long.
On admission Mrs. K’s ulcers were treated with Aquacel Ag, Mesorb held in place with sofban and crepe. She had pain on admission and was prescribed Oramorph for pain control. After consultation with the Tissue Viability CNS we were advised to change the dressing to Urgotule with a silver version for severe infections.
This had a slight improvement to the overall condition of her legs but was only just holding the infection at bay and was not significantly improving the wound. It did reduce her pain on dressing change to the point that she no longer requires the Oramorph.
After one month
On further consultation with the TV CNS she suggested we try Actilite honey dressings as wound contact layer, with Eclypse absorbent dressing to contain the exudates. We retained the sofban and crepe. We decided to try Actilite on the Right leg first as this was the smallest area with the least exudates. Within two weeks of treatment the wound had shown signs of improvement. The exudates levels were reduced and the wounds were showing signs of epithelialisation. The Actilite was changed every week and the outer dressings changed daily due to the exudates levels. After 4 weeks of treatment there is a significant improvement to the wound. The pictures do not show the improvement as well as the naked eye.
After 8 weeks
Since the improvement was so significant we decided to treat the other leg in the same way. This is also showing an improvement but it is not as rapid as the left leg. Mrs. K will never be able to walk nor will she comply with any exercise routine. We don’t anticipate a complete recovery however Mrs. K’s quality of life will be significantly improved by the treatment given.