Inflammation Relief Provides Key to Healing for Patient with Circumferential Pyoderma Gangrenosum

Abstract

Problem:

A 37-year-old female ulcerative colitis sufferer developed an excruciatingly painful slough- filled lower leg pyoderma gangrenosum. Topically, only bismuth tribromophenate/petrolatum gauze dressings were tolerated. The patient required 6-8 propoxyphene/acetaminophen/day to keep her continuous pain at 5/10-8/10. Despite high doses of steroids, the wound increased to ~10cm x 7.5 cm. Replacing dapsone with cyclosporine for three weeks failed to decrease the wound size and/or pain, so the patient decided (with physician consent) to try extra-thick polymeric membrane silver dressings (SPMDs) with email/telephone guidance.

Patient-centered goals were:

1) Decrease pain to permit wearing warm socks; 2) Close wound; 3) A more cosmetically acceptable scar than from a previous PG wound.

Rationale:

Pyoderma gangrenosum is a notoriously painful inflammatory wound. Manual debridement is contraindicated. SPMDs can help dramatically decrease pain and inflammation while gently continuously debriding wounds and promoting brisk wound healing. Bacteria are killed as they come in contact with silver PMDs. Extra-thick SPMDs provide cushioning and additional absorption.

Methodology:

The patient changed the nonadherent SPMDs herself with frequent clinician email/telephone guidance, faithfully emailing digital photographs and faxing data collection sheets documenting every wound-related intervention. Initially, she sprayed tap water on the wound bed at dressing changes to decrease the dressing application’s impact (the dressing absorbed the free water before pulling fluid/slough out of the wound bed). SPMDs were changed twice daily for 8 weeks, then daily. Manual wound cleansing was never required.

Outcomes:

The wound was markedly cleaner and measurably smaller by day four. The patient rapidly weaned herself off narcotic pain relievers. At less than one month, she wore warm socks. The wound fully closed in 31⁄2 months. The patient was pleased with cosmetic outcome.

Conclusion:

SPMDs, used persistently, resulted in decreased inflammation, excellent pain relief, brisk slough removal, and healing to closure. All patient goals were met or exceeded.

References:

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2. Sessions R. Can a drug-free dressing decrease inflammation and wound pain? What does the evidence say? Poster #3436. 41st Annual WOCN Conference June 6-10, 2009 St. Louis, MO. USA 3. Wollina U. Pyoderma gangrenosum – a review. Orphanet Journal of Rare Diseases. 2007; 2:19.
4. Agathangelou C. Large necrotic malodorous pressure ulcer closed using unique silver dressings. Poster #35. NPUAP 11th Biennial Conference February 27-29, 2009. Arlington VA. USA.
5. Benskin LLL. PolyMem Wic Silver Rope: A multifunctional dressing for decreasing pain, swelling, and inflammation. Advances in Wound Care. 2012 Feb;1(1):44–7.