Granulox
®
haemoglobin spray
6
Case report
5
This patient was a 47-year-old
male who had been diagnosed with
chronic venous insufficiency (CVI)
following recurrent episodes of deep
vein thrombosis (DVT) as a result
of continuous intravenous drug
use. This resulted in oedema and
he had been living with a chronic
leg ulcer for more than four years,
with several episodes of wound
deterioration.
Before being seen by the author,
the patient was being visited twice-
weekly by a practice nurse and a
range of dressings had been tried
on his wound, including honey
and silver dressings, and a charcoal
dressing to combat the malodour.
He had also undergone Doppler
assessment to determine his ankle
brachial pressure index (ABPI)
before being placed on a two-layer
compression system (KTwo
®
; Urgo
Medical). However, during the
past four years the ulcer had gone
through different phases of healing
without ever being completely
resolved (
Figure 1
).
At the time of writing, the patient
had given up his drug use and taken
a day job in a rehabilitation unit
as a counsellor. However, having
a painful leg constantly impacted
on his day-to-day life and he was
embarrassed about the malodour
emanating from the wound.
Due to an increase in pain, odour
and exudate volumes, the patient
became non-compliant with the
compression therapy, removing the
bandages every few days. At this
point he was referred to the author
for reassessment and advice.
At the author’s assessment, it became
clear that the patient’s main goal
was to improve his quality of life by
minimising the pain and healing
the ulcer. On inspection, the wound
itself measured 10x6x1.0cm and was
critically colonised with 100% grey
slough. There was also malodour
and high volumes of yellow/brown
exudate. The periwound was also red
and excoriated (
Figure 1
). The patient
stated that he was experiencing
significant pain (scoring ‘8’ on a
scale of 1–10, with‘10’ being the
worst pain).
Figure 1.
Patient’s leg ulcer showing areas of
slough and excoriated periwound skin.
Figure 2.
Wound showing size reduction and
growth of granulation tissue.
As the grey-coloured slough clearly
indicated lack of oxygen and the
wound bed had been stagnant for
too long, the patient was started on
a haemoglobin spray-on solution
(Granulox
®
) along with the same
dressing regimen. Granulox was
sprayed directly into the wound bed
from a distance of 5cm. Due to the
high volume of exudate, the wound
was then covered with a highly
absorbent pad (KerraMax Care
®
;
Crawford Healthcare), as well as
an activated charcoal dressing to
reduce malodour. The surrounding
skin was then moisturised with an
emollient before the compression
bandaging was again applied from
toe to knee.
Going forward, the plan was to
continue with the new regimen, with
weekly dressing changes.
Figure 2
shows the wound bed after three
weeks’ treatment with Granulox. The
wound now measured 10x5x0.5cm,
with 50% sloughy tissue. The
periwound skin was drying out and
the exudate had turned clear and
amber-coloured. The patient’s pain
score had reduced to ‘5’ and the
charcoal dressing was discontinued,
as the odour had also been
considerably reduced.
The wound continued to improve
until the final consultation at week
eight, by which time there was 100%
granulation tissue in the wound
bed and the overall wound size had
reduced to 1.5x1.0cm. There was no
sign of infection, the periwound skin
was healthy and the exudate volume
was low. Similarly, the patient’s pain
level had reduced to ‘1’. Granulox
was continued until the final stages
of healing and the patient was
moved into compression hosiery,
as both the oedema and exudate
volumes were being well controlled
(
Figure 3
).
The patient declared himself happy
that after four years in compression
bandages he could now wear shorts
and go to the beach. He no longer
felt embarrassed about odour from
the wound and felt generally more
confident, even getting a new
counselling job. He was also free
of pain and had stopped taking
tramadol and ibuprofen.
Figure 3
Towards the end of the treatment period,
the wound had reduced significantly
in size and showed extensive
epithelialisation.
The patient in this case had a history
of drug abuse that had resulted in
a chronic leg ulcer of four years’
duration. Eight weeks of treatment with
Granulox reduced the wound’s size
and, more importantly, had a positive
impact on the patient’s daily life.
