Dr. Sundaram Ravikumar, MBBS, FRCS (C)
Dr. Steven Tan, MBBS
Background:
Patients with venous leg ulcers (VLUs) typically come to the office for weekly evaluation and Unna’s boot placement. During the pandemic, our VLU patients had a difficult time getting access to care. To overcome this challenge, we developed a VLU home treatment protocol incorporating two novel products, a self-applied inelastic air compression device (Aero-Wrap™) and air-bolster wound dressings (AeroBolster™).
Methods:
A retrospective review of patients with active VLU who underwent our home treatment protocol was included in this case series. Patient demographics were collected, VLU characteristics were recorded, and photographs were reviewed. Inclusion did not have limitation on VLU size or duration. Patients with active infection were excluded from the treatment protocol.
The initial phase of the treatment protocol included a primary layer of Unna’s boot, followed by a self-adherent elastic bandage, and then the Aero-Wrap™ applied on top. Patients continued this treatment, returning to the clinic as needed to manage drainage in this initial phase (1-2 weeks). Once the swelling was reduced and the wound progressed in the right direction the VLU home treatment protocol was initiated.
Patients were taught to clean their wounds with Dakin’s solution after bathing, apply the AeroBolster™ dressing, and then apply Aero-Wrap™ with 30-40mmHg of compression over it. This was repeated every 2-3 days as dressings became saturated. Patients had a telemedicine visit every 3-4 days and were brought into the clinic every 2 weeks for in-person assessment until healing.
Results:
A total of 5 patients were treated with the VLU home treatment protocol. There were 2 men and 3 women with a mean age of 65.4 years. Comorbidities included hypertension, diabetes, arthritis, and hypothyroidism, and the mean BMI was 35. The average VLU duration at initial treatment was 78 weeks, with a range of estimated wound areas from 5cm2 – 161.5cm2 with a mean area of 39.6cm2. Two of five of the patients had endovenous thermal ablation performed.
All patients were able to self-manage their wound care at home with physician supervision after an initial phase. There were no complications observed. All 5 patients had a significant reduction in wound size and depth and 4 out of 5 patients successfully had their VLU healed within 12 weeks. The mean treatment time was 11.4 weeks. This treatment protocol resulted in an estimated total reduction of 25 clinic visits.
Conclusion:
Home treatment of VLU with a self-applied inelastic air compression device (Aero-Wrap™) and an air-bolster wound dressing (AeroBolster™) is feasible and may reduce weekly patient clinic visits. A larger study will be required to show the efficacy of this approach.
