Multipronged management of chronic non-healing venous leg ulcers using advanced wound dressings and patient-centered care: a case report.

Abstract

Venous leg ulcers are chronic wounds that can persist for years and severely affect quality of life, especially when complicated by infection and metabolic disturbances. This case is atypical, as it documents the complete healing of long-standing, bilateral venous leg ulcers that persisted for nearly a decade and became complicated by the onset of type 2 diabetes and Pseudomonas aeruginosa infection. The report highlights a hypothesis that prolonged inflammation in chronic wounds may contribute to metabolic dysregulation, while also demonstrating how an integrated outpatient multipronged management strategy can achieve complete healing without hospitalization. A 65-year-old South Asian man with a 10-year history of non-healing venous leg ulcers on both legs presented with foul-smelling discharge, thickened wound edges and social isolation due to odor. He had been diagnosed with type 2 diabetes 5 years ago and hypertension for 10 years. On examination, he had a large left-leg ulcer measuring 13 × 10 cm and two right-leg ulcers measuring 11 × 11 cm and 7 × 7 cm. Laboratory tests showed elevated inflammatory markers (C-reactive protein 248 mg/L, erythrocyte sedimentation rate 102 mm/h), mild anemia and wound swab culture/sensitivity positive for Pseudomonas aeruginosa, sensitive to meropenem and amikacin. Management included debridement, antibiotic therapy and application of a bioactive collagen-nanosilver gel dressing with a four-layer compression bandage. Nutritional counseling focused on high-protein meals, vitamin D and zinc supplementation, and adequate hydration. Regular family counseling sessions and follow-up visits were conducted to ensure adherence, leading to complete healing of all ulcers with restoration of mobility and self-care ability. No recurrence of ulcers was observed during follow-up. This case demonstrates that a multipronged outpatient approach combining targeted antimicrobial therapy, bioactive collagen-nanosilver wound dressings, nutritional optimization, and patient and caregiver education can result in full healing of chronic, infected venous ulcers while reducing the need for inpatient care. It also raises the hypothesis that chronic systemic inflammation from long-standing ulcers may predispose to metabolic dysfunction. Further prospective studies are needed to explore this potential link and to evaluate the reproducibility and cost-effectiveness of such multidisciplinary interventions in chronic wound management.