This is a report of the treatment of a diabetic Ulcer with Cutimed Sorbact. The treatment consists out of the following components: 1. Antibiotics tested for the relevant bacteria 2. X-Ray to determine if the infection has gone outside the affected area 3. SorbAct gauze compress, SorbAct Gel gauze compress Pre-trial all standard treatments have been tried, ea: EUSOL(+zinkoxide), Alginate, Aquacel, Silvernitraat without any positive result. Contra references: http://nhg.artsennet.nl/kenniscentrum/k_richtlijnen/k_nhgstandaarden/n HGStandaard/M16_std.htm Pro references: www.cutimed.nl/documents/cutimed_sorbact.pdf http://www.cutimeduk.com/downloads/cutimedcs02-2007proof.pdf http://www.youtube.com/watch?v=mbelplfsie4 www.wfi.ch/sites/dl/download/cutisorb-sorbact.pdf Website: www.diabeticulcers.eu Important notice: this report is not medically founded, does not follow common medical path and has no support from the medical world, not by choice but by their refusal to cooperate. This report is based on a personal study in combination with an advanced product selection technique(fate), after a very disappointing result (1* amputation) by only using standard treatments and failing to pursue the treatment policy by a full professional medical team and nurses. 1*; The patient in question has given her unreserved and full permission to pursue alternative treatment after the failure by a full professional medical team. This report has been made and is released with a very important footnote to the reader, If your specialist is not willing to open their eyes, then open your own 2011-1 diabetic ulcer on foot EN.doc Page 1 of 14
Final Update: 9-3-2012 10-7-2011 started with SorbAct external(http://www.cutimed-sorbact.nl/), AB clindamycine 300mg 3x/day. Complete Ulcer environment infected, after 6 days sorbact below results. 16-7-2011 20-7-2011 (dia = 3.02[2.74] cm) 21-7-2011 24-7-2011 (dia = 2.93[2.66] cm) 2011-1 diabetic ulcer on foot EN.doc Page 2 of 14
28-7-2011 (dia = 2.95[2.68] cm) 29-7-2011 (dia = 2.73[2.48] cm) 3 weeks SorbAct, environment Ulcer clean and free of infection, Ulcer has reduced in size, tried SorbAct Gel, environment is getting too wet thus returning to SorbAct without gel. Environment skin is well perfused, Ulcer is not shedding much other then what SorbAct is absorbing. SorbAct as of 27-7 only applied on Ulcer and not anymore over the entire outside area. AB still being used for internal treatment. (No natural light available, discoloring is caused by environment) 31-7-2011 (dia = 2.98[2.7] cm) 2-8-2011 (dia = 2.75[2.5] cm) 2011-1 diabetic ulcer on foot EN.doc Page 3 of 14
3-8-2011 (dia = 2.77[2.5] cm) 4-8-2011 (dia = 2.59[2.35] cm) 6-8-2011 (dia = 2.86[2.6] cm) 7-8-2011 (dia = 2.52[2.29] cm) 9-8-2011 (dia = 2.2[2.0] cm) 12-8-2011 (dia = 2.15[1.9] cm) 2011-1 diabetic ulcer on foot EN.doc Page 4 of 14
15-8-2011 (dia = 2.15[1.9] cm) 16-8-2011 (dia = 2.01[1.8] cm) 18-8-2011 (dia = 2.08[1.9] cm) 21-8-2011 (dia = 1.96[1.7] cm) Removed skin to improve healing process, on the top right there is a small part visible of another Ulcer but it does not seem to run through, probably caused by the thick skin layer. The form of the Ulcer changes over time. 23-8-2011 (dia = 1.76[1.6] cm) 25-8-2011 (dia = 1.82[1.6] cm) 2011-1 diabetic ulcer on foot EN.doc Page 5 of 14
More skin surgical removed over the new Ulcer area, results are not visible on this photo. 27-8-2011 (dia = 1.66[1.5] cm) 29-8-2011 (dia = 1.69[1.5] cm) It is difficult to determine the diameter because of the oval shape, the width is 10% smaller and the height 20% smaller, the extension at the top right is also smaller and less layered(skin), from 27-8 to 29-8 there is a slight swelling that has reduced by 50% on 31-8. Possibly the positive effect of removing excess skin on 27-8 (see notes). 31-8-2011 (dia = 1.5[1.4] cm) Surprise after removing skin, the Ulcer is not round but extends, SorbAct has been able to do some but not the maximum. Ea. an uninterrupted red line does not always mark the entire Ulcer. 2-9-2011 (dia = 1.06 x 2.17 cm) 2011-1 diabetic ulcer on foot EN.doc Page 6 of 14
Visibly a clear improvement since 2-9. End measure points unclear 4-9-2011 (dia = 1.19 x 2.16 cm) 06-9-2011 (dia = 1.1x x 2.1x cm) 8-9-2011 (dia = 1.09 x 2.05 cm) 12-9-2011 (dia = 1.16 x 2.1 cm) 14-9-2011 (dia = 0.99 x 1.99 cm) 17-9-2011 (dia = 0.96 x 1.94 cm) 2011-1 diabetic ulcer on foot EN.doc Page 7 of 14
19-9-2011 (dia = 0.76 x 1.78 cm) 23-9-2011 (dia = 0.74 x 1.82 cm) More skin surgical removed on 25-9, results are visible on this photo. Here a lump is forming, it s unclear if this is bone or a new Ulcer. 26-9-2011 (dia = 0.69 x 1.69 cm) 30-9-2011 (dia = 0.55 x 1.76 cm) Skin(slough) surgical removed on 4-10, after a shower the area slightly enlarged. The lump from 30-9 is gone. 2-10-2011 (dia = 0.39 x 1.44 cm) 5-10-2011 (dia = 0.41 x 1.46 cm) 2011-1 diabetic ulcer on foot EN.doc Page 8 of 14
7-10-2011 (dia = 0.35 x 1.40 cm) 9-10-2011 (dia = 0.29 x 1.45 cm) Measure points difficult to determine, visually it is still shrinking. 12-10-2011 (dia = 0.37 x 1.41 cm) 15-10-2011 (dia = 0.28 x 1.29 cm) 17-10-2011 (dia = 0.26 x 1.34 cm) 24-10-2011 (dia = 0.19 x 1.25 cm) 2011-1 diabetic ulcer on foot EN.doc Page 9 of 14
29-10-2011 (dia = 0.17 x 1.2 cm) 4-11-2011 (Split heling) 9-11-2011 (Continued closing) 13-11-2011 (Slough removed) 17-11-2011 (Closing fase 1/3) 21-11-2011 (Closing fase 1/3) 2011-1 diabetic ulcer on foot EN.doc Page 10 of 14
28-11-2011 (Closing fase 1/3) 8-12-2011 (Closing fase 1/3) Finally found a specialist who is positive about this treatment, surgical intervention(1-8) on the right (younger) Ulcer which caused a slight trauma in the older left Ulcer. Resulting in a slight drawback of the healing process but a better closure on the right (2 months younger) Ulcer. 14-1-2012 (Closing fase 2/3 left, 1/3 right) After a month with some backlash, ea. fall, flu, still some progress. The left Ulcer is closed since 1-12-2011 and is staying closed, the right Ulcer wants to close but isn t getting there yet. The age difference with the left indicates the right needs more time. 22-1-2012 (Closing fase 3/3 left, 2/3 right) Reached another milestone after 1 week, no excretion visible (right), also sorbact is clean this time. The skin (left) is nearly recovered. We will continue with sorbact because of properties 9c and 9d. 2011-1 diabetic ulcer on foot EN.doc Page 11 of 14
9-3-2012 Full closure! This will be the final picture in these series and treatment over 8 months. The vertical line on this view is an impression left from a sock. The tissue area looks a little bit raw but will even out over time as rehabilitation has been restarted, a lot of walking will do the same when it comes to the rawness of a diabetic skin. 2011-1 diabetic ulcer on foot EN.doc Page 12 of 14
Bandage method: SorbAct(4 layers=default packaging) with Fixomull stretch(1 layer) (nothing else). At start, large area 16-8 smaller area 2011-1 diabetic ulcer on foot EN.doc Page 13 of 14
General reference / observation: 1) Walking on foot recommended to aid perfusion but not to exaggerate. 2) Do not flush the wound, rinse with bandage, after drying replace bandage, let the area dry if needed for about 30 minutes (it is normal the Ulcer gets enlarged by rinsing) 3) Rinsing a Ulcer irritates the area and slows healing, leave dry and terminating skin and use it to allow the forming of new skin underneath, when the old skin is dry a new layer sits underneath and the dry skin can be gently torn of. If the top layer gets too thick surgically remove excess. 4) When changing bandage press the skin around the Ulcer to determine if the outer skin is attached and to press out/remove pus. When the outer skin is not attached consider removing it 5) Use SorbAct on the Ulcer and a 15milimeter area around it, do not cut sorbact in a circle 6) Continue antibiotics until the Ulcer is gone, the wound itself does not need to be fully closed, any infection is caused by the Ulcer 7) When a crust has formed try to move the crust slightly, if the crust moves independently then you need to remove it, something is happening underneath it. If the crust feels like it is attached leave it as it is unless the skin around it shows signs of irritation (red) 8) Only use Fixomull stretch from BSN medical and no other product, this is the only product that does not damage a diabetic skin 9) SorbAct has a number of combined properties that can not be seen elsewhere in a single product / treatment. a. Kills all bacteria (EUSol) b. Pulls pus and infected material from the wound / Ulcer (Alginate) c. Aids in forming new skin (Aquacel) d. Regulates the moisture balance (there is discussion about this property, it is looking more like interaction between the glue of fixomull stretch and sorbact) e. When the skin is really dry use SorbAct Gel 10) When the Ulcer is getting smaller then the current sorbact compress you can keep the other halve of the compress for a maximum of 24 hours 11) Twice a week keep the Ulcer open to let it dry out for about 1 hour with only a simple compress on it 12) Replacing sorbact can be done every other day if the bandage does not get wet, during a 2 months period it shows that changing sorbact every day results in a better healing process. 13) SorbAct has a positive effect on wound-slough and reduces the need for surgical removal. 14) 12-9-2011: X-Ray confirmation infection is local and not penetrated. 15) Nb. 2-2-2012: During closing fazes do not stop the sorbact treatment until the skin is fully equal to the surrounding area and no visible discolorment. 16) The amount of sorbact layers can be reduced during closing fazes, the working area may need to be equaled out with (additional) small sorbact patches to get maximum contact where it is needed. The smaller the ulcerated area the more difficult it is to get sorbact contact, it is imperative contact takes place for sorbact to do it s thing. 17) During closing fazes sorbact may be left for a maximum of 4 days, unless it gets wet or the sorbact patch looks exhausted. A website directly related to this document can be viewed as: www.diabeticulcers.eu 2011-1 diabetic ulcer on foot EN.doc Page 14 of 14