Treatment of Large Painful Lower Extremity Ulcer with Edema and Deep Vein Thrombosis (DVT) Using Transforming Powder Dressing (TPD)

The management of lower extremity (LE) wounds in patients with chronic edema is challenging. Edema may be present for many reasons, including deep venous thrombosis (DVT), which can result in morbidity and mortality if not properly treated. 1,2 Skin damage, prolonged healing times, infection, malodor, and diminished quality of life (QoL) all may develop from excessive wound exudate.3 Pain, another common issue in both LE wounds like venous ulcers, as well as LE chronic edema, can negatively impact patient compliance with seeking wound care , further reducing time to healing and QoL. Case Study: A 39-year-old male presented with DVT, chronic RLE edema, and a large leg ulcer. He only sought treatment after being unable to walk. Circumferential excisional debridement through muscular fascia was performed and wound vac was applied over the wound (1350cm2).

Four days later, a second debridement was done along with wound vac change, followed by split thickness skin graft (STSG) placement with continued vac therapy two days later. The patient reported high levels of pain and was prescribed hydromorphone, oxycodone, and hydrocodone. The wound was non-responsive to treatment and approximately 2 weeks after STSG placement, the wound vac was discontinued.

We investigated the effectiveness of a novel transforming powder dressing (TPD) in treating this extensive painful leg ulcer that was non-responsive to either standard of care (SOC) and advanced wound therapies. TPD is made of biocompatible polymers that aggregate upon hydration to form a moist, oxygen-permeable matrix that protects the wound from contamination while managing exudate through vapor transpiration, as well as some negative pressure effects on the wound. Patient’s pain score reduced from 9 to 3. TPD was re-applied 1 week later, and pain score was reported as 0-1. Additional TPD was applied 6 days later, and pain score was reported as 0. Two weeks later, no additional TPD was required, the wound was fully healed.

The patient was discharged.In conclusion, based on the outcome of this patient challenged by comorbidities and pain, treatment of patients with wounds associated with DVT which are refractory to SOC should be considered for treatment with TPD.