The use of Algivon dressing on the treatment of a 57 year old grossly obese male with chronic lymphoedema and recurrent cellulitis.

Tracey Burnell - Tissue Viability Nurse, Warwick Hospital

Past Medical History

• Gross obesity (BMI 62.5)
• Congestive Cardiac Failure
• Atrial Fibrillation
• Chronic Lymphoedema
• Recurrent Cellulitis

Diagnosis on Admission

• Chronic Lymphoedema of lower limbs with associated infection.
• Leg ulcers.
• lschaemic left foot.
• Fast atrial fibrillation secondary to infection.
• Conservative treatment from Vascular surgeons, Microbiologist Consultant, Tissue Viability Nurses, Dermatology Nurses, Dieticians, Physiotherapists, Occupational Therapists.
• Frequent admissions with shortness of breath, cellulitis, chronic lymphoedema, atrial fibrillation, poor concordance with medications including Warfarin.
• Eventually admitted by GP due to further deterioration, inability to get up from chair and poor social situation.

Initial Tissue Viability Assessment

• Extensive lymphoedema to the waist.
• Grade 4 pressure ulcers to both heels - necrotic dry eschar.
• Left heel I 0cm x 6cm.
• Right heel 2cm x 2cm.
• Left calf macerated with extensive superficial skin loss.
• Left thigh and both buttocks extensive grade 4 pressure damage extending entire back of thigh and across both buttocks - all dry, very "leathery" eschar with some slough.
• Surrounding skin macerated and excoriated.
• Exudate - extremely malodorous and very large volumes.

Wound Care Plan

• Algivon applied to all areas of grade 4 tissue damage to aid autolytic debridement, provide antimicrobial environment and improve malodour.
• Eclypse Adherent applied to all wounds over Algivon to manage exudate and protect surrounding skin from further maceration and accompanying skin breakdown.

• Dressings secured with tubular bandage.
• Emollient applied to all intact skin to improve
skin condition.
• Dressings to be changed as often as needed
according to levels of exudate.
• Nursed on Bariatric bed and high risk pressure
relieving mattress.
• Microbiology - wound swab - Staphylococcus
aureus + + +
• Group G streptococcus + + +
• Blood culture - Staphylococcus aureus and group G Streptococcus.

Four weeks following admission wounds to both heels fully debrided and showing healthy granulation tissue, surrounding skin slightly macerated due to excessive exudate which has been difficult to manage -Algivon dressings continue.

Wound to back of thigh also fully debrided all dry eschar removed good areas of
epithieliasation and granulation.

Pressure ulcers to buttocks slower to debride than others areas but eventually achieved with use of Algivon.

On discharge

• Wounds to both heels and back of thigh almost fully epithieliased and wounds to
buttocks fully granulated and approximately 50% epithieliased.
• Diet improved under care of dieticians - high protein diet and significant weight loss.
• Medication improved heart failure and diuretics improved oedema.
• Antibiotics treated infection.
• Physiotherapy improved mobility.
• Occupational therapists improved
accommodation and social circumstances.
• Discharged to the on going care of the District Nurses.