Case Study: Diabetic Patient with Skin Tear

An 86 year old woman injured her leg while biking. This resulted in one large (~8x4cm) and two smaller (1×2 cm) skin tears in her right calf.

The patient is active and lives independently. She suffers from diabetes type 2, but she does not use any medication for this condition. However, she has been following a strict diet successfully. There were no underlying pathologies present that could have been of influence on wound healing.

The registered nurse was able to visit her on the same day the wounds occurred.

The wound was first cleansed thoroughly with tap water. The skin flaps were secured with the L-Mesitran Tulle. This was covered with an absorbent pad and an elastic bandage. The wounds were treated daily in the beginning. At later stages, the wound was treated once every 2-3 days. 

After several days of treatment, the big skin flag began to become very dark, without being necrotic. The discoloration was perhaps due to old dried-up blood. The wound edges were parting due to the mobility of the leg. In the open part of the wound, some fibrinous slough formed, which was not easy to remove. 

To dissolve this slough the wound, the wound was treated once for 3 days with a hydrocolloid dressing, which was applied on top of the tulle. After 3 days, the wound area was slightly macerated, but the fibrinous slough was easily removed. Thereafter, the treatment was resumed with L-Mesitran Tulle which was cut to the appropriate size to fit the wound. 

The patient developed oedema in the legs. Therefore, tubifast was applied, which gave good results. The big skin flap showed good improvement after some time and had completely grown and reattached itself to the underlying tissue. In 2 months, these skin tears completely healed without significant scarring.