Many therapists using DEEP OSCILLATION® are now using it as a treatment for ulcers with very effective results, Christine Talbot, SRN, MLD Practitioner and Lymphoedema Therapist has provided PhysioPod™ UK Ltd with the following Case Study and pictures. For a ZIP file of this case study with more pictures contact PhysioPod™ UK Ltd
Visit Two: Deep ulcer on the medial aspect of the left calf
Visit Six: Shows the brownish tinge following treatment with the laser, periphery tissue granulation and shrinkage of the ulcer.
Taken 8th April 2011
Male, Age 61, Heavy smoker until 1989, (30 per day habit) Heavy drinker until 2009.
Previous Activities: Judo, Boxing, London Marathon 1993
Bronchitis as child, Nose bleeds as child, Large umbilical hernia, Arthritis, (shoulders and fingers), Type 2 diabetic, (Gliclazide/Metformin), High blood pressure, (now medicated, resting BP 100/60). Frequent headaches, Cerebral aneurysm, Cellulitis x2 (Clindamycin), Weight gain ++, Bilateral lower limb lymphoedema with lymphorrea, Chronic ulceration of both legs
Allergy to Flucloxacillin and Intravenous Flagyl, MRSA Positive, repeat antibiotics for the last two years,
1970/1980's Fractured ribs(left), ulnar, radius, six fingers, (boxing injury),
1987 Cerebral haemorrhage,
1994 Angina, cardiac catherters, (cardiac pumps to heart chambers)
1994 Rotary cuff repair, (right side x 2 attempts)
1995 Rotary cuff repair, (left side x 2 attempts)
2000 Clipped cerebral aneurysm, (screws and clips)
2000 Removal of ganglion to right ankle, (multiple complications, repeat surgery x5, open wound, debridement, packing and failure to heal)
2002 Multiple insect bites to both legs, severe infection/ cellulitis,
2004 Bilateral leg ulcers for past six years,
This patient presents with a multitude of problems and a lengthy clinical history with severe complications. He has significant bilateral lower limb lymphoedema, with non healing leg ulcers, lymphorrea,, lymphangiomata, papillomatosis and hyperkeratosis, further complicated by repeated episodes of MRSA. He is on a cocktail of medications and repeatedly takes regular strong analgesia for pain, his abdomen is hardened and distended due to chronic constipation caused by Oramorph.
Signs and symptoms:
Both lower limbs were heavily engorged with fluid and lymph (lymphorrea) leaking out. The skin was excessively dry, flaking, and hardened with brown pigmentation (hyperkeratosis) to both legs, made worse by repeatedly soaking the legs at least three times per week in a potassium permanganate solution, which was extremely caustic to the skin and in particular to a large leg ulcer on the medial aspect of his left calf, equally the toe nails were severely stained dark brown and had split, further ulceration appeared on the lateral aspect of the left calf as a puncture type hole, which was also leaking. And both heels were deeply cracked and bleeding. At the first appointment this patient was in a lot of pain and discomfort. He complained of a deep ache in both legs, had difficulty in walking and appeared breathless on exertion. He visited his surgery three times a week for dressings. He felt his quality of life was poor and he could see no end to repeated infection and failure to heal. He had requested for the deeply ulcerated leg to be amputated. The ulcerated wound had an unpleasant smell of tissue decay.
Both legs were washed in Rosa Mosqueta soap and dried gently in muslin cloths. Ulcerated areas were soaked in Aloe Vera Juice. A red low level laser was applied to ulcerated areas with very good effect, causing visible drying and shrinkage. Hivamat 200 treatment was performed on the neck, abdomen and legs at varying frequencies, the ulcer was covered in cling film and worked directly over with the Hivamat. The ulcerated area was re cleaned following treatment, swabbed with Aloe Vera Juice and laser therapy repeated. Epaderm with Roas Mosquet Oil was applied copiously to the lower legs. Both legs were bandaged in multi layer lymphoedema bandaging, short stretch to the right leg and long stretch to the left, ulcerated leg.
Advised not to scrub the legs with a flannel, warned of cross infection etc! Advised to soak both lower legs in an Epaderm/ water solution and to dry thoroughly with a hair dryer on a low heat setting. Advised not to keep touching the wound and infected areas, in order to avoid cross contamination and spread of infection. Discussed skin care and wound management. Discussed diet, (food management) and exercise. Demonstrated specific exercises to initiate the muscle pump in the calves and ankles. Suggested a Power Plate or Stepper machine to aid drainage and improve circulation. Suggested taking specific vitamin and mineral supplements to support the immune system but to check with the GP first, so as not to conflict with any other medications.
Treatment is ongoing with twice weekly visits to the Practice Nurse for dressings as well as receiving all aspects of manual lymph drainage and complex decongestive therapy from myself. Following the initial drainage treatment, it was very encouraging to see a marked improvement in healing and size reduction of the ulcer. The colour, tone and skin integrity of the limbs was much improved, whereby both legs felt less heavy, less painful and walking was easier. On examination, the calves had softened slightly, the popliteal nodes were less engorged, the feet were smaller and less rigid, both cracked heels had much improved and the ulcer was smaller with less leakage and only spot leakage from the right leg. After four treatments the overall condition of both limbs continues to improve with lessening fibrosis due to the Hivamat and there is evidence of tissue repair around and through the ulcer caused by both the laser and the Hivamat.
The patient requires less analgesia and is able to walk with relative ease and no breathlessness.
It is regrettable this patient has again tested positive for MRSA, but I hope by improving circulation and lymphatic drainage with the combination of manual lymph drainage and complex decongestive therapy, that the persistence of MRSA can finally be eradicated and this gentleman will regain his quality of life after six years of chronic infection.
Christine Talbot, SRN, Lymphoedema Practitioner. MLD and CDT Wareham, Dorset, England Email: firstname.lastname@example.org
Read featured article in CHOICE HEALTH AND WELLBEING about how Christine has helped other sufferers of Lymphoedema with DEEP OSCILLATION® therapy
PhysioPod™ UK Ltd would like to encourage other therapists to come forward with success stories using DEEP OSCILLATION® for ulcers.