Patient data / anamnesis:

88-year-old patient, present after tetraparesis in sepsis with acute renal failure and spondylodiscitis BWK I and II, decubitus of the right buttock half, massive swallowing disorders. Admission to the hospice on 11.06.2015. 

On 16.06.2015 the situation was as follows: A dry necrosis measuring approx. 4 cm x 2 cm had clearly demarcated itself. The wound environment was visibly reddened and hardened during palpation. 

As aroma care mixture we decided for the "Wound care mixture A" according to Maria Hoch: 20 ggt Cajeput (Melaleuca cajeputi), 50 ggt Lavender fine (Lavendula angustifolia), 20 ggt Basil (Ocimum basilicum), 10 ggt Rose geranium (Pelargonium graveolens), 60 ggt Tea tree (Melaleuca alternifolia), 10 ggt Thyme linalool (Thymus vulgaris ct linalool), 20 ggt Thyme thymol (Thymus vulgaris ct thymol), 20 ggt Cinnamon bark (Cinnamomum verum) 

From the basic mixture we added 10 ggt to 100 ml NaCl 0.9%. We sprayed this solution onto the necrosis, let it dry slightly and covered the decubitus with a foam bandage. Unfortunately, no side storage was possible with us either. The patient was bedded on an alternating pressure mattress and we carried out micro positioning. All pressure exposed areas were rubbed with our "skin care oil" twice a day for decubitus prophylaxis: 15 ml jojoba oil (Simmondsia chinensis), 35 ml sweet almond oil (Prunus dulcis), 8 gtt lanvendel fine (Lavandula angustifolia), 5 gtt benzoin siam (Styrax tonkinensis), 2 gtt carrot seeds (Daucus carota). 

The size of the decubitus did not change significantly, but the necrosis continued to dissolve and so we continued unchanged until the following condition (Fig. 2.8.4) became apparent on 8 July 2015 when the dressing was changed: The hard necrosis had completely dissolved and was only connected to the centre of the wound bed. The wound edges were well supplied with blood, but also swollen. I reduced the number of drops of the basic mixture to 5 ggt per 100 ml NaCl 0.9%, as we now went directly to the wound treatment with the essential oils. 

A dressing change was carried out daily. 

On 15.07.2015 we recorded the condition of the wound again: Slowly we saw the full extent of the damage. Since the necrosis remains continued to dissolve, we got a better view "into" the wound. The decubitus went deeper than we thought. Now more wound secretion was emptied, so that we had to change the dressing twice a day. It seemed to use a cleaning. In order to catch the secretion better, we changed the dressing material. We now used a gently adhesive foam bandage, applied additional absorbent compresses and fixed everything with a transparent bandage film. In this way, the resulting wound odour was also to be contained. 

Another photo documentation on 21.07.2015 showed: The necrosis had completely dissolved, thick fibrin coatings "stuck" to the wound bed. The wound environment showed well supplied with blood, but still raised wound edges. In addition, wound pockets were now clearly visible. These were rinsed out with the wound care mixture, then the entire wound was sprayed again extensively. We retained the dressing technique. 

From 25.07.2015, a new cleaning phase of the wound seemed to begin, as significantly more wound secretion was formed again. At times, the wound had to be dressed 3 times a day so that a new treatment was discussed in the team. We opted for LIGASANO®, which was inserted exactly into the wound cavity. In addition, the wound was covered with another layer and absorbent dressings were used. Of course, everything was fixed again. We kept the direct wound treatment. 

The first successes were already apparent two days later. The dressing only had to be changed twice a day, as significantly more secretion was absorbed by the dressing material. The fibrin coatings became increasingly detached and the wound odour was clearly contained. The wound was still rinsed out and sprayed with the wound care solution each time the bandage was changed. 

On 02.08.2015 we recorded the condition of the wound again photographically: The fibrin coatings had almost completely loosened and the wound cavity was now much better visible. The wound bed appeared clean and well supplied with blood, as did the somewhat swollen wound edges. Wound exudate hardly formed and so there was no excessive wound odour. With this result we maintained the current wound care. 

We carried out the next photo documentation on 11.08.2015. The wound cavity had been well cleaned and there were hardly any fibrin deposits left. The necrosis was also completely resolved. The wound odour was also barely noticeable and the wound exudate had also strongly decreased in the quantity. The wound was still well supplied with blood without coatings and wound odour. 

I put together a new wound care spray: 2 ggt incense arabic (Boswellia sacra), 2 ggt benzoe siam (Styrax tonkinensis), 1 ggt camomile blue (Matricaria recutita), 3 ggt carrot seeds (Daucus carota), 4 ggt Lavender fine (Lavandula angustifolia), 2 ggt Myrrh (Commiphora molmol), 3 ggt Rose geranium (Pelargonium graveolens),[nbsp] 5 ggt Sea buckthorn pulp oil in 200 ml NaCl 0,9 %. The wound was treated with this mixture daily during the dressing change. 

The new photo documentation took place on 17.08.2015 and showed a small fibrin deposit adhering to the wound bed at 1 o'clock. The remaining wound was free of other coatings, hardly secreted and no wound odour was perceptible. The procedure for wound treatment was maintained. 

On 27.08.2015, the current wound situation was captured again photographically: The fibrin deposit at 1 o'clock had loosened, so that the entire wound bed was free of deposits. The wound showed a good granulation tendency and the dressing was changed as usual. 

On 13.09.2015 the wound had visibly decreased in size and depth. The wound edges were well supplied with blood and so we changed the dressing material. Furthermore, a strip of LIGASANO® white sterile was inserted into the wound cavity for tamponade of any wound secretions that might occur. Then the wound was covered with a Zetuvit absorbent dressing and fixed with Opsite foil. The wound mixture was retained. 

On 27.09.2015 the wound depth was further reduced by granulation tissue. The wound margins were well supplied with blood and the wound size had further decreased. At this wound condition, we maintained the current treatment until 6.10.2015. Then a purulent greenish coating had formed on the wound. 

In addition there was a very bad smelling wound odour and so the wound care spray was adapted: 6 ggt Manuka (Leptospermum scoparium), 6 ggt Niauli (Melaleuca viridiflora), 4 ggt Chamomile blue (Matricaria recutita), 10 ggt Lavender fine (Lavandula angustifolia), 10 ggt Palmarosa (Cymbopogon martini), 4 ggt Immortelle (Helichrysum italicum), 8 ggt Peppermint (Mentha piperita), 10 ggt Sea buckthorn fruit oil in 200 ml NaCl 0,9%. We kept the wound material and changed the dressing daily. 

On 10.10.2015, i.e. two days later, the wound dressing had already reduced significantly and there was no longer any perceptible wound odour. So it seemed that we were on the right track and so we continued. 

Another photo documentation was carried out on 15.10.2015: The wound bed was again completely free of deposits and granulated visibly. A wound odour was no longer perceptible. The entire wound was reduced in size. 

We carried out the last photo documentation on 25.10.2015: The healing tendency of the wound was still evident. The wound was completely free of irritation. The treatment of the wound with essential oils was agreed with our team of doctors at all times of the treatment. Since the general condition of the man had stabilised, the accommodation in a hospice was no longer suitable. With the family in the apron already for a better accommodation for him was looked for and thus the transfer took place on 26.10.2015 into an old people's home.  

After almost one month our guest has settled in very well and enjoys his gained quality of life. While most of him wanted to lie in bed in the same position, he is regularly mobilized into the wheelchair and takes part in the employment program. 

Author: Tanja Kapell, specialist nurse for anaesthesia and intensive care, aroma expert, Bodelschwingh-Hospiz Haus Franz, Dülken 

Patient data and anamnesis: 

53-year-old dark-skinned man with complete paraplegia sub Th8 after occupational accident 1996, after recurrent decubitus ulcerations in the past years, colostoma attachment December 2015, VY Plastik gluteal 2017; after anasarca, cardiomyopathy, diabetes mellitus type II. 

Currently large-area, superinfected decubital ulcer stage 4 sacral: 

•     Length 13 cm, width 7 cm, depth approx. 1 cm, wound margin 0.2 cm undermined 
•     Wound margin very strongly macerated 
•     no signs of inflammation 
•     Exudate mediocre, odour inconspicuous, deposits (biofilm) visible 
•     Tendency to bleed after mechanical debridement 

Wound treatment:

Compresses impregnated with sterile wound irrigation solution were applied to the wound for 15-20 minutes, after which the biofilm was removed intensively with LIGASANO® Wound Cleaner®. Then LIGASANO® white sterile wound dressing mini was inserted into the wound, covered with LIGASANO® white sterile 10x10x1cm, secondary covering with non-sterile LIGASANO® white. Fixation with Fixomull stretch and soft trousers. 

Interim results after two months of treatment with LIGASANO®: 

The wound develops relatively slowly towards healing. Only small steps in the right direction are visible. Concomitant diseases in the patient make the process more difficult. Intensive controls and stamina were particularly in demand here. Intensive cooperation with the team was necessary. Good arrangements with the family doctor were essential. 

Conclusion:

In consideration of the patient's wishes for freedom (daily excursions of more than 6 hours in a wheelchair or daily showering), the generally desolate general condition (kidney, thyroid and FC values) and a severely infected fistula wound at the trochanter, the wound has healed under consideration of sterile wound care. The basic conditions in a patient with cross-section are a great challenge in wound treatment due to the skin temperature fluctuations that are difficult to assess (sweat formation, cooling or overheating). A good success in only 8 months. 

Authors: Advivo ambulante Beatmung GmbH, Munich, under the direction of Carola Boser, PDL, Dr. med. Luis Antonio da Silva Jäger, Munich