An 80-year-old, obese, female patient with a 40-year history of diabetes mellitus presented several wounds accompanied by swelling of the lower extremities. A culture swab confirmed infection with methicillin resistant Staphylococcus aureus (MRSA). The patient’s diabetes is managed by injection of 25-30 units of insulin daily. For a duration of 15 days, the treatment of the wounds was restricted to the use of conventional antiseptic solutions such as povidone iodine and neomycin sulphate without covering them with bandages, easily allowing colonisation of the wound. As a result, the patient experienced pain which greatly discomforted her.
- Products: L-Mesitran Ointment and Net
- Case study done by: Dr. Nektarios Tatavilis, General Practitioner in Xanthi, Greece
Starting 29 May 2018, monotherapy with L-Mesitran was implemented to address the present MRSA infection without the use of antibiotics and progress the wound towards healing. Therapy comprised a regime of daily dressing changes. A thin layer of L-Mesitran Ointment was applied to the wound and complemented by the use of the L-Mesitran Net dressing (10×10 cm) before covering it with non-woven, sterilized gauzes (10×10 cm; 10×20 cm, Zetuvit Plus, Hartmann) as the top absorptive layers. In the third week the Mesitran products were changed to L-Mesitran Soft wound gel and L-Mesitran Tulle (10x10cm).
In the second week of treatment, autolytic debridement resulted in opening the infected and heavily exuding wounds. Four days later, the infection was controlled and the wounds fully debrided and cleared of necrotic tissue. In week three, the patient announced experiencing a tingling sensation, most likely due to the infectious condition and the high osmotic effect L-Mesitran Ointment exerts. From this point, the L-Mesitran Soft wound gel was applied, restoring the patient’s comfort. In week four, healthy granulation tissue of the extended areas could be observed with many wound areas reduced in size and pending towards closure. Since initiation of the treatment, oedema had decreased significantly and by week five also erythema disappeared completely which translates into the progression from inflammation towards healing. Finally, at the end of the seven-week period since the L-Mesitran products were implemented, the diabetic ulcers are deemed fully and successfully healed without reinfection.
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In the past twenty years, the relationship between stress and delayed healing has been established and research suggests that in order to minimise a delay in wound healing, interventions should be implemented to minimise the patient’s psychological discomfort (1). Likewise, patients’ expectation of a painful event can result in experiencing pain before the treatment commences as the central nervous system is already receiving pain signals. Downstream, this stress and anxiety related to anticipatory pain leads to a vicious cycle of delayed wound healing as avoidance behaviour is put into effect, resulting in more pain, more dressing and more pain at dressing changes (1).
L-Mesitran has proven to be an effective modality for tending to infected diabetic ulcers and restoring patient comfort without affecting blood glucose levels (2). In this case, the wounds healed completely in a total of seven weeks, equalling one tube Ointment (50g), 14 pieces of Net, one tube Soft (50g), and 7 pieces of Tulle. Furthermore, the patient didn’t experience pain during the dressing changes, which can be accredited to the moist wound environment that L-Mesitran was able to maintain.
References
- Upton D, Upton P. Psychology of Wounds and Wound Care in Clinical Practice. Chapter 3. Springer Cham Heidelberg New York Dordrecht London.
- Kirby P, Khan N, Dhillon N, Emmerson E, Fisher A, Thompson J, Burnside J, Chesterton L, Fernando D. Do honey-impregnated dressing affect glycaemic control? The Diabetic Foot Journal 2009;12(4): 177-180.