Clinically Infected Bilateral Heel Pressure Ulcers

in a mentally ill patient

A 59-year-old, chronically mentally ill female patient presented with bilateral heel pressure ulcers. Her severe psychotic disorders, combined with a lack of compliance and prolonged immobility led to these ulcers. The ulcers were classified as stage III since the underlying subcutaneous tissue was affected. Previous treatment with a povidone-iodine solution for 1 month was ineffective.

Products: L-Mesitran Soft and L-Mesitran Tulle.
The case study was done by: Georgios E.Papanikolaou, MD PhD, GP Plastic Surgery Private Practice, Ioannina, Greece.
Publication: This case report is part of a peer-reviewed case series published in the journal ‘Antibiotics’.

Upon first evaluation, the wound dimensions on the right heel were 5 cm in width and 6 cm in length, and on the left heel 4 cm in width and 5 cm in length. The ulcer showed clinical signs of infection, including malodor, a high amount of exudate, slough, necrosis, and delayed healing. Due to her psychiatric disorders, the level of pain could not be assessed.

Treating the Heel Pressure Ulcers

L-Mesitran Soft was applied to the wound and followed by L-Mesitran Tulle. The L-Mesitran products were combined with a secondary foam dressing. Wound dressings were performed by the healthcare professional at 48-hour intervals.

Surgical debridement was impossible due to the lack of patient compliance, so treatment only consisted of local therapy with medical grade honey (MGH) products of L-Mesitran. After 14 days of treatment, the autolytic action of MGH was clear, and indications of infection had resolved. Besides this, the wound area decreased in size and was gradually replaced by granulation and epithelial tissue. Due to the positive developments of the wound, the dressing changes were transitioned to every 4 days instead of every 2 days. The wound on the right heel was completely healed after 108 days of therapy with L-Mesitran products. After 118 days, the heel pressure ulcer on the left foot was completely healed without any further complications.

Pressure ulcers at the heel are one of the most common pressure ulcers and are usually severe due to the vulnerability of the heel. Non-healing heel pressure ulcers have a massive impact on the patient’s quality of life and are often caused by bacterial infections.

Medical Grade Honey is an effective wound care product, as it simultaneously exerts antimicrobial and wound-healing effects via multiple mechanisms. These multifaceted effects not only contribute to the ability of MGH to treat a broad spectrum of bacteria, but it lacks the risk of resistance.

The antimicrobial effects of MGH rely mainly on the acidic pH, the high osmotic pressure due to the high sugar content, and the release of hydrogen peroxide after the enzymatic breakdown of sugar. In addition to its antimicrobial activities, MGH also promotes wound healing by keeping the wound moist, stimulating autolytic debridement, and exerting anti-inflammatory and anti-oxidative effects.

In conclusion, MGH-based products are clinically and cost-effective for treating hard to-heal pressure ulcers, such as heel pressure ulcers, and can be proposed as an alternative or complementary to antibiotics and surgery. Furthermore, MGH-based products are easy to apply at home and are cost- effective. This will lead to improving the patient’s quality of life.