L-Mesitran Tulle for Necrotic Diabetic Foot Ulcer

A 43 year old male patient with diabetes (uncontrolled HbA1c1) was admitted to the hospital. The admission was primarily for pneumonia, but also to control his diabetes and a lower leg ulcer that was present for about 3-4 months.

The patient had been applying various natural ointments prescribed by his natural healer. On initial assessment, the wound was covered with necrotic tissue and the lower leg was extremely edematous. The wound also had a foul odour and surrounding erythema was visible. A honey-based dressing was chosen as honey has proven qualities as a debriding and antimicrobial agent.

The wound was first cleansed using saline water. Thereafter L-Mesitran Tulle was applied on the wound. This was covered with a 3M Tegaderm foam and then dressed with Profore 3 layer compression bandage to apply altered compression.

The patient is diabetic and although his ABPI was measured at
0.95mmHg, the nurse decided to use the altered compression,
as she believed the wound might have a mixed etiologic due to
the location (lateral malleolus).

The pressure of the bandage was also in inverse proportion to the circumference of the limb, thus the pressure could be higher at the ankle as this patient’s circumference was about 23cm at the ankle. The nurse chose a 3 layer compression as a safer option in this particular case.

The patient’s Ankle Brachial Pressure Index (ABPI) was measured
at 0.95mmHg, which is normal. The ABPI measurement is crucial in application of compression bandaging as it is indicative
of arterial blood supply to the lower leg and will influence the
choice of compression. Toes pressure were normal.

Dressing changes were done twice in a week for a period of 6
weeks. The wound decreased significantly in size. The smaller wound on the top right was even almost completely epithelialized. The sloughy tissue was debrided with ease and healthy granulation tissue was visible within 20 days. L-Mesitran Tulle provided a fast and almost pain free debridement