This article is about a patient with a history of multiple surgeries, including a left leg amputation, who presented with signs of pre-sepsis and significant challenges in wound management.
Despite undergoing various treatments such as NPWT, fish skin application, hyperbaric oxygen therapy, and split skin grafts, no approach yielded satisfactory results. Frequent, painful dressing changes added to the burden, severely affecting the patient’s quality of life.
The goal of treatment was to find a solution to stabilize the wound, create a dry wound surface, and eliminate the pain associated with dressing changes, ultimately improving the patient’s overall quality of life outside the hospital setting. In response, DEBRICHEM® was introduced into his treatment plan. Owing to its versatility, DEBRICHEM® worked on this end stage case, as well as it works on other broad spectrum of wounds. It helped meet the clinicians’ goals for this case and resulted in:
✅ Stabilized wound with dry and clean tissue
✅ Successful patient discharge and home-based care
✅ Prevention of further deterioration and hospital re-admissions
✅ Reduced risk of complications
✅ Reduced need for hospital based interventions
What It Meant for the Clinicians and the Patient?
For the clinician, this successful management of a case that had previously defied all conventional treatment approaches, represented a significant step forward. The successful stabilization of the wound offered a tangible solution to reducing the risks associated with prolonged infection and sepsis.
For the patient, the application of DEBRICHEM® brought relief from the constant pain associated with wound dressing changes and provided a viable pathway for managing the wound at home, thus improving their overall quality of life and reducing hospital dependence.
Broad-Spectrum DEBRICHEM®
This case is a testament to the broad-spectrum action of DEBRICHEM® in removing biofilm and infection. Even in end-stage cases like this it helps improve the quality of patients’ remaining life time by making the wound more manageable. This manageability is a result of benefits that usage of DEBRICHEM® brings along like removal of infection and inflammatory response, decreased pain, prevention of complications, reduced risk of re-infection, and promoting granulation.
Guideline Followed to Report the Case
This case was published in International Journal of Surgery Case Reports in alignment with the consensus-based surgical case reporting guideline (SCARE guidelines). These guidelines ensure the comprehensive documentation and ethical reporting of complex surgical cases, providing clarity on the methodology and the results of the treatment approach. The publication is originally titled Innovative Biochemisurgical Treatment for Stabilisation of an End-Stage Chronic Wound in a Complex Vascular Compromized Patient. You can access it for free via a link provided at the end of this article.
Case in Detail
Patient Background:
Patient was a 55-year-old male with a complex medical history that included vascular compromise and diabetes mellitus. He had been a smoker for over 30 years, and his condition was classified as ASA III by the American Society of Anesthesiologists, indicating moderate to severe systemic disease, complicating his case further.
The patient had already undergone multiple operations, including an above-the-knee amputation of the left leg at another hospital, and used a prosthesis for mobility.
He arrived at Euregio outpatient clinic after a delay in seeking medical attention, which had allowed his condition to worsen significantly. Upon presentation, he exhibited signs of pre-sepsis. His case was further complicated by advanced Peripheral Arterial Occlusive Disease (PAOD), classified as Fontaine Class IV, indicating the most severe form of arterial blockage that significantly impairs blood flow to the extremities.
Wound at Presentation
The primary concern for coming to the hospital was blistering and ulceration on the stump area of the left leg, probably caused by non-proportionate pressure from his prosthesis. This pressure has been a well-known risk factor for developing non-healing ulcers, which are notoriously difficult to treat. The patient’s wound was not only infected but also failed to heal after months of treatments.
Medical and Surgical Challenges
Medical team conducted biopsy, including wound cultures and a medical microbiological consultation. This testing made it clear that surgical debridement and antibiotic treatment were needed. The patient was therefore started on Pipracilline/Tazobactam, an antibiotic combination.
But no surgical options could be implemented as patients’ PAOD posed a major barrier. Revascularization, a procedure designed to restore blood flow to the affected areas, was unfortunately unfeasible for the patient. The arteries in the left iliac axis and groin were completely occluded, leaving no viable pathways for re-establishing blood flow. All major arteries were closed, and blood flow was only maintained by collateral circulation, a less efficient route. With no landing zone available for revascularization, no further surgical options could be pursued.
In addition to this the advanced stage of PAOD significantly impacted the wound’s healing capacity and made conventional therapies less effective.
Biofilm and Necrosis: Persistent Barriers
Chronicity of this case was also a result of the persistence of infection and particularly biofilm: cluster of microbes protected by extracellular polymeric substances (EPS). Biofilms are highly resistant to antibiotics and antiseptics, as well as to the body’s own defense mechanisms, making them difficult to treat with conventional therapies. They create a hyper-inflammatory environment, impeding the healing process by promoting prolonged inflammation.
Similarly, necrosis, which contains dead tissue and microorganisms, further hampers the healing process by complicating tissue regeneration. For successful management of the, both biofilms and necrosis needed to be effectively addressed, with rigorous debridement being the conventional method to remove these impediments.
Treatments Tried
This patient’s treatment journey began when he was admitted to the hospital for a wound infection and underwent re-amputation with diagnostic subtraction angiography. Over the course of following year, the patient faced multiple re-admissions and various treatments, including,
- Vacuum therapy (NPWT), which uses negative pressure to promote healing
- Grupss therapy (which was not effective in this case)
- Fish skin application as a bioactive dressing
- Platelet enriched plasma-therapy
- Split-skin grafting, to cover the wound with healthy skin
- Hyperbaric oxygen therapy in specialized clinics in Münster and Düsseldorf
Despite these interventions, the wound persisted as a chronic, non-healing ulcer. Each attempt was unsatisfactory and nothing succeeded in any form, leading to frustration for both the patient and the medical team.
What Did the Clinicians Want to Achieve for this Case?
The primary goal of the clinicians was to stabilize the wound by getting rid of biofilm and infection, create a dry and clean wound bed, and provide a pathway for home-based care.
➡️ A more manageable wound. Given the complexities of the patient’s condition and the failure of previous treatments, the goal was not only to stop the progression of infection and sepsis but also to provide the patient with a more manageable wound.
➡️ Reduction of associated pain. One of the main challenges was the intense pain caused by the daily changes of regular wound dressings, which were distressing for the patient. So, the clinicians aimed to transition the wound into a stable, dry surface, so that the pain associated with dressing changes can be eliminated.
➡️ Minimize the need for frequent hospital visits. This approach was intended to minimize the need for frequent hospital visits, improve the patient’s quality of life outside the hospital and allow for the wound to be managed at home.
Inclusion of DEBRICHEM® in the Treatment Process
After several months of unsuccessful treatments, DEBRICHEM® was introduced into the patient’s care plan. Initially, it was used alongside Vacuum Therapy, followed by 2 additional applications of DEBRICHEM®, one each month, without Vacuum Therapy.
The treatment protocol followed the Instructions for Use (IFU) provided for DEBRICHEM®, which stipulated that the agent should be applied for a duration of up to 1 minute. Below is the step-by-step treatment protocol that was used:
- Initial Preparation:The wound and surrounding periwound skin were cleaned. This step is essential to prepare the wound for optimal agent application.
- Application of DEBRICHEM®:TDA was carefully applied directly to the lesion, extending about 1 cm beyond the wound margin. The agent was left for exactly 60 seconds, as per the protocol outlined in the IFU.
- Post-application Procedure:After the 1-minute application period, the TDA was diluted and removed by gently rinsing the area with sterile water or saline.
- Pain Management:To minimize discomfort, the wound bed was pretreated with appropriate anesthesia, and the procedure was carried out under general anesthesia in this case.
- ASA Classification Consideration:The patient’s ASA Class III status, indicating moderate to severe systemic disease, emphasized the need for a tailored, careful approach to the treatment. Each step was meticulously planned and executed to mitigate any additional risks, considering the patient’s overall health and medical history.
DEBRICHEM® Dealt with Persisting Biofilm & Infection: How Did it Work?
DEBRICHEM® debrides through a targeted biochemical reaction with water in the biofilm, releasing an impressive amount of energy—approximately 1500 kJ/mol. This energy denatures and carbonizes the biofilm’s extracellular polymeric substance (EPS), breaking down its structure and destroying its contents. Over time, the denatured and carbonized material detaches from the wound surface. As it remains in place initially, granulation tissue begins to form underneath, creating the foundation for healing. By eliminating the biofilm barrier, DEBRICHEM® facilitates granulation and reopens the natural path to wound recovery.
What Was Achieved?
The rapid desiccation properties of DEBRICHEM® effectively eliminated biofilm and necrotic tissue. The desiccation effect was virtually immediate, causing tissues to denature, coagulate, and separate from the underlying surface.
This resulted in:
➡️ Stable Wound Environment. The creation of a stable wound environment, characterized by dry and clean wound tissue, reducing the burden of infections.
➡️ Reduction in Pain. This transformation allowed the wound to be managed with significant reduction in pain associated with daily dressing changes.
➡️ Home-Based Care & Reduced Risk of Complications. By fostering the growth of clean, dry necrotic tissue, the wound became more manageable, even in the patient’s home setting, facilitating easier care and reducing the risk of further complications.
➡️ Improved Quality of Life. The result helped improve the patient’s quality of life outside hospital and reduced the need for frequent hospital-based interventions.
The Role of Multidisciplinary Care
This case also underscores the importance of a multidisciplinary approach in managing complex poorly healing wound cases. In the treatment strategy at Euregio Hospital, wound specialists, nurses, microbiologists, vascular and endovascular surgeons, anesthesiologists, medical prosthetic experts, and rehabilitation experts ensured comprehensive care tailored to the patient’s unique needs. The collaboration of these specialists was essential in achieving a successful outcome and improving the patient’s overall health and quality of life.
Next Steps for Wound Management
For clinicians seeking interventions for poorly healing wounds’ management, DEBRICHEM® offers a promising option. If you’re dealing with end stage complex wound cases, consider exploring how DEBRICHEM® can help stabilize them, reduce infection risks, and improve patient outcomes.
👉 Request a demonstration at your clinic: Request a Demonstration – Innovating The Future of Wound Care
👉 Download the full publication here: https://www.debx-medical.com/scientific-papers/
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