READ: Healing complex wounds and improving patient quality of life with innovative electrical stimulation wound therapy
Wednesday, 1 December 2021
By Linda Howell, Clinical Nurse Consultant

First published in WoundConnect, December 2021

The following case study is of a patient with a complex leg ulcer. As well as looking at the clinical efficacy of advanced modalities such as Accel-Heal® 12 day electrical stimulation wound therapy in improving healing outcomes, the case study considers the impact that living with a chronic wound has on patients’ wellbeing and quality of life.

Accel Heal is a 12 day electrical stimulation wound therapy (Class 11A) that has been demonstrated to be effective in wound healing (Tadej et al, 2010; Taylor at al 2011). The treatment consists of six 48-hour single use units, to be applied consecutively, and electrode pads. The pre-order to modify specific functions in dermal tissue (www.accelheal.com). Treatment is delivered via electrode pads placed on the healthy skin either side of the wound. As an adjunct treatment, Accel Heal can be applied alongside the patient’s wound therapy regimen and can be used under compression bandaging. Accel Heal is now available in Australia via Alliance Medical Solutions (info@alliancemedicalsolutions.com.au). 

Background 

Mrs LK is a 67-year-old lady who is married with three children and works full time in a factory setting so is on her feet all day. She is usually an active member of her community and likes to socialise with her family and friends. Mrs LK reported the effects of living with her venous leg ulceration as “absolutely debilitating” and “the most terrible experience of my life”. She described her overall quality of life as “the worst possible” due to the physical symptoms that affected her daily life. 

Mrs LK experienced pain that prevented her from sleeping. She reported feeling extremely anxious and stressed as she was unable to work because of the pain and the side effects of the analgesia which made her feel very drowsy. The ulceration also impacted on her ability to perform her activities of daily living and she had to rely on her family for assistance which made her feel a “burden” to them. 

Over the years, a multidisciplinary team of Health Professionals had been involved:
 
  • Wound  & Vascular clinics (x3 hospitals) 
  • Pain specialist 
  • GP 
  • Dermatologist 
  • Infectious Disease specialist
  • Dietitian (dietary supplements for wound healing)
  • ‘QUIT’

Assessment and prior treatment

Mrs LK presented to my clinic with circumferential Venous Leg Ulceration which was first identified in 2013 (8 years earlier). 
The wound bed was friable with some slough, tissue erosion and high levels of exudate with recurrent biofilm formation. 
She had repeated hospitalisations for infection and a combination of oral and IV antibiotics. A number of procedures had been carried out, including:
 
  • Wound Biopsy 2015: Venous Leg Ulcer
  • Venous scan 2018: Venous disease
  • MRI 2018: NAD
  • Arterial Duplex 2018: NAD


Mrs L reported severe pain throughout this episode of care, requiring opioid medication. There were recurrent infections (Pseudomonas, Beta Haemolytic Strep, Strep G, Staph Aureus) with odour and tissue oedema noted.

Medical history
 

Mrs LK had been diagnosed with:

  • Psoriasis

  • Hypertension

  • Varicose veins

  • Venous insufficiency with stasis dermatitis

  • Nil Diabetes

  • Chronic back pain

  • Varicose Veins

  • Increased BMI

 

'Before', at presentation.

At the time of presentation, Mrs LK was being prescribed Diovan® & Midol®. She was a smoker (5-10 per day) and had a normal diet and fluids. The possibility of using Accel-Heal was discussed with Mrs L and a decision was made to commence treatment with the objective of reducing the wound size and managing pain.
 

Treatment outcome

The medial ulcer on her left leg was the original wound treated six years earlier. It was extremely painful and circumferential.



The wound measured 75mm x 45mm when treatment with Accel Heal began, 29 July 2021 (Day 1).

Below positioning of electrodes, dressings and compression bandages show how the device was managed in this chronic venous leg ulcer.


By Day 3, less analgesia was required with pain occurring mostly after dressing changes and less biofilm was evident as the wound improved.

On Day 7, pain increased significantly to 10/10, and the exudate level increased. At the client’s request, the top layer of compression bandaging was removed.

By Day 9, pain was assessed as 7/10 prior to dressing change but it increased in the evening, requiring additional oral analgesia.
 


At this stage, exudate was moderate and purulent, though the wound size had decreased.

Some biofilm was present distally which was debrided using Debrisoft® and a Sorbact dressing was applied.

Accel Heal treatment was ceased after twelve days and the wound continued to improve.

At four weeks post treatment initiation, wound size had decreased by more than 60% with less exudate, nil odour, and reduced pain.

Twelve weeks post application of Accel Heal, and despite an infection requiring a course of antibiotics, the wound had significantly reduced in size and depth with decreased pain, exudate and nil odour. The assistance of a research librarian at this stage is invaluable.
 



Conclusion

In summary, the client was amazed and delighted at how quickly the wound improved and felt that, for the first time, she could see ‘a light at the end of the tunnel’ as far as healing her chronic wound was concerned. She looks forward to using Accel Heal on her other wounds so she can finally get back to work.

As a clinician, it was exciting to see almost immediate progress with reduced slough and less purulent exudate. For chronic wounds where healing has stalled, I would recommend Accel Heal as part of your toolbox, alongside best practice wound management.

References

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