49 years old male patient with giant bilateral circumferential leg ulcers, due to an autoimmune Raynaud vasculitis.
Fig. 1: Initial aspect before any treatment: one can see the huge ulcers, very deep, involving even the fascial layer of the calves.
Fig. 2: Closer image of the same patient, before treatment: both legs were covered with necrotic tissue and debris and have a large amount of septic exudate.
Fig. 3: After three weeks of passive debridement using LIGASANO® white, the most part of the necrotic tissues were replaced by a very good granulation layer and the septic discharge obviously decreased.
Fig. 4: The same patient, detailed image of the right leg, where the granulation tissue developed and covered the most part of the circumferential ulcer. Even the necrotic fascia has now been granulated.
Fig. 5: Due to the great amount of exudate, the ulcers were covered with LIGASANO® white, 2 cm thick. This dressing was changed 3-4 times a week.
Fig. 6: The same way in which LIGASANO® white is wrapped around the wound.
Fig. 7: Wound aspect after about five weeks of passive debridement with LIGASANO® white: the most part of the ulcers is covered with very good granulation tissue, that penetrates even the honey-comb cells of LIGASANO®. This explains the small bleeding when the dressing is replaced.
Fig. 8: The same aspect of the right calf, where a small fascial slough is still persisting and will be debrided with the next dressings before grafting.
Fig. 9: Due to the local vascular effect of LIGASANO® white the blood flow increased in the wound base and the sorrounding tissues, with good consequences for the entire wound healing process. This photo was taken in the operation room before grafting.
Fig. 10: The very clean wounds from the previous images were grafted with meshed split-thickness skin grafts, anchored by absorbable 3/0 running sutures.
Fig. 11: On the left side seperate sutures were placed because more graft sheets were necessary to cover the whole wound surface.
Fig. 12: One week after the operation all grafts “have taken” due to the very good wound bed created by the granulation tissue, which appeared after the passive debridement with LIGASANO® white.