Patient Background:

A 78-year-old male, bedbound and incontinent, residing in a group home, developed a severe pressure ulcer on his right heel due to prolonged immobility. He had multiple risk factors including advanced age, muscle weakness, a history of falls, and limited mobility.

Clinical Challenge:

Upon initial evaluation, the patient presented with a stage 4 pressure injury on the right heel. The wound was unstageable due to thick slough and biofilm buildup, and there were concerns of chronic inflammation and the potential for infection. The patient had already failed to make progress with traditional wound care measures.

‍Our Approach:We implemented a full-circle, home-based wound care protocol that combined hands-on expertise with evidence-based clinical interventions:

Initial Wound Hygiene & Debridement:

Removed necrotic tissue and biofilm through selective debridement.
Applied antimicrobial dressings to reduce bacterial load.

Adjunctive Ultramist Therapy

Initiated bi-weekly low-frequency, non-contact ultrasound therapy to disrupt bacterial biofilm, reduce inflammation, and support angiogenesis.

Moisture Balance & Dressing Selection

Used advanced dressings like silver gel, foam padding, and Xeroform to promote a moist healing environment.

Pressure Offloading

Utilized offloading heel boots and repositioning every 2 hours.Ensured low air loss mattress was in use.

Nutrition & Supplementation

Patient was placed on a high-protein diet with nutritional supplements including Juven and multivitamins.

Caregiver Education

Trained caregivers on wound care, signs of infection, and incontinence management.Emphasized the importance of repositioning and prompt cleansing after incontinent episodes.

Results

Over a span of 5 months, the wound progressed from a heavily sloughed, unstageable ulcer to a nearly fully epithelialized and infection-free site:

‍Wound size decreased from 2.3cm x 2cm x 0.5cm to 1cm x 1cm x 0.2cm.

Pain consistently reported as 0/10.No infections or hospitalizations occurred during care.