Autolytic debridement of a large, necrotic, fully occluded foot ulcer using a hydrocolloid dressing in a diabetic patient.

OBJECTIVE: The aim of this article was to review the authors' experience with hydrocolloid dressings in foot ulcers, especially in diabetic patients. Engineered as part of stomal flange, hydrocolloid dressings established their presence in wound care management after successfully protecting peristomal skin. They are occlusive dressings and have been valued for their ability to support autolytic debridement, thus removing necrotic tissue--a barrier to healing--from the wound bed. These dressings have received negative attention, however, after a number of case reports indicated the products as a possible cause of wound deterioration, amputation, and death, when used on foot ulcers. Therefore, in general, their use has been discouraged in the treatment of foot ulcers. The authors present a case in which a hydrocolloid dressing was used to successfully debride a large, necrotic, fully occluded foot ulcer in a diabetic patient.

DESIGN: A case report.

SUBJECT: A 60-year-old man with diabetes, post-renal transplant, with a large necrotic lesion on the lateral ankle, likely secondary to a burn.

RESULT: There was complete resolution of the wound in 25 weeks. Consistent use of hydrocolloids over 10 weeks healed a fully necrotic wound bed to complete granulation and the initiation of epithelialization. Infection was not a complication in this case. The wound has remained closed after 12 months.

CONCLUSIONS: Removal of necrotic tissue from the wound bed was evident after using hydrocolloid dressing, thus expediting healing of the wound. It was accomplished with frequent monitoring and respecting contraindications to the use of this product. This treatment was invaluable in effectively liquefying necrotic material in the wound bed in a noninvasive manner. The authors recommend consideration of using this type of dressing for similar lesions to more effectively and hastily remove barriers to healing, provided that the wounds are not infected and patients do not have peripheral arterial disease and are not severely medically compromised. Frequent monitoring and dressing change are also mandatory.