Case Studies

CASE STUDIES

Using innovative Accel-Heal electrical stimulation therapy in the treatment of hard-to-heal wounds

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Despite therapy advances in The majority of patients require dressing Accel-Heal is an innovative A single use, small, portable device that can HARD-TO-HEAL wound management over the last changes at least twice a week and HOW ACCEL-HEAL electrical stimulation therapy for be discreetly tucked away and can easily be WOUNDS CONTINUE 30 years, hard-to-heal wounds are more than a third require daily dressing ADDRESSES THESE hard-to-heal wounds which relieves managed by patients in their own homes. an increasing problem. changes, putting pressure on health pain and stimulates healing. TO BE A MAJOR care practitioner caseloads. [3] PROBLEMS There is no complicated set up and therapy The total cost of leg ulcers in the UK Accel-Heal has been designed to provide is started with the simple push of a button. BURDEN has been estimated to be around Hard-to-heal wounds can be extremely advanced therapy in a simple format that The therapy is subsensory and safe to use.[7] £1.9bn each year. [1] painful - between 50% and 60% of patients can be used to complement standard with chronic wounds experience persistent wound care. The annual cost of managing an unhealed wound pain. [4, 5] venous leg ulcer (VLU) is 4.5 times more than that of managing a healed one. [2] Pain influences many aspects of wound therapy. One major issue is that pain can make some gold standard therapies such as compression unbearable; this can lead to reduced compliance and worse outcomes. Wound pain can also severely impact patients’ quality of life. HOW ACCEL-HEAL IMPROVES OUTCOMES

Electrical stimulation has the potential The European Wound Management RELIEVES STIMULATES IMPROVES PATIENT WHAT IS ELECTRICAL to alleviate these problems. It is a proven Association (EWMA) has also therapy method for wound management acknowledged that electrical stimulation WOUND PAIN HEALING QUALITY OF LIFE STIMULATION [13][7] [13–15] [14–16] which has been used by specialists and is effective in treating a wide range of researchers for many years. wound types including venous leg ulcers, diabetic foot ulcers, pressure ulcers It is one of the most evidence-based and mixed ulcers. [9] wound management technologies available, reported in at least 30 Electrical stimulation is proven to improve randomised controlled trials.[6, 7] healing [6,9] whilst reducing pain [10, 11] and Its use has been recommended by the inflammation [12]. Specific subsensory European Pressure Ulcer Advisory Panel stimulation from devices such as to treat stage 2 to 4 pressure ulcers. [8] Accel-Heal® is safe to use. [9] SAFE COST [7] EFFECTIVE However, electrical stimulation [7] has not been widely adopted into everyday practice. Many established, hospital-based devices are complicated for healthcare practitioners to use. Patients are inconvenienced by the need to visit the hospital for therapy During Accel-Heal therapy patients can continues long after the therapy period has and would rather be treated at home. [9] THE EVIDENCE expect to find that pain is relieved and the been completed, putting them on the road normal healing process is stimulated and to recovery.

83% >80%

12DAYS 20WKS

83 per cent reduction in pain Over 80 per cent of non-healing during 12-day therapy [13] wounds healed in 20 weeks [13–15] accelheal.com accelheal.com 4 5

Better quality of life Accel-Heal can also be used to Accel-Heal works by delivering a preset, Chronic wounds are believed to lack this HOW ACCEL-HEAL manage patient pain in order to allow HOW ACCEL-HEAL automated programme of subsensory electrical charge - applying electrical Patients have reported marked investigations such as blood flow testing electrical pulses to the wound that stimulation is believed to replicate this BENEFITS PATIENTS WORKS [10] pain relief following therapy with or other therapies such as debridement automatically adjusts itself to different natural stimulation, promoting healing. Accel-Heal [7,13] with some patients to be carried out which the patient might patients to deliver effective therapy from Accel-Heal relieves pain and stimulates reporting rapid improvement within not otherwise be able to tolerate. [17] the moment it is switched on. A normal healing by directly affecting cell behaviour hours of commencing therapy. [17] wound usually has a small, naturally in and around the wound bed. Being entrusted with their occurring electric charge across it. These cellular changes suggest that This has enabled patients to reduce, Accel-Heal device promotes a sense of This charge normally orchestrates the Accel-Heal may dampendown the or come off pain relieving medication self-sufficiency and control in patients complicated wound healing process by inflammatory environment that is present completely [18, 19] and even return and may help to prepare them for their instructing cells in the wound bed to go in complex wounds. Case studies have [24] to work.[19] future self-care with, for example, into ‘healing mode’. reported a visually apparent reduction in [21] wound inflammation in as little as 7-days compression stockings. [14] Patients were also able to return after applying the Accel-Heal device. to normal social activities thanks Better movement and exercise to experiencing less pain and increased mobility.[14, 18] Improved blood flow, stimulated by movement, can improve the chances Better compliance to gold of wound healing - as wound pain can standard compression worsen during movement, this can be very difficult for patients. Patients treated with Accel-Heal were able to tolerate full strength Patients treated with Accel-Heal HOW ACCEL-HEAL compression as a direct result of noted huge differences in their ability to its pain relieving benefits. [19, 20] move about freely compared with the IMPROVES OUTCOMES restrictions they had experienced before therapy, making it easier to exercise. [14, 18]

Accel-Heal reduces the overall cost of ACCEL-HEAL IS hard-to-heal wound therapy by: Patients with a hard-to-heal Patients who are frustrated Patients whose wound pain wound that is not progressing by the reduced mobility causes them to be non-compliant COST SAVING to healing caused by their pain to therapy £936 1/3 34% 11% REDUCING THE PER REDUCING THE REDUCING THE REDUCING THE COST PATIENT COST OF COSTS OF DRESSING NUMBER OF OF THERAPY OF MANAGING A VLU BY CHANGES BY UP NURSING VISITS VENOUS LEG ULCERS UP TO £936 TO A THIRD NEEDED PER PATIENT TO THE NHS [27] [22] PER YEAR BY 17, A BY 11%[23] 34% REDUCTION [23]

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Accel-Heal was started in December Three days after starting Accel-Heal CASE STUDY ONE REDUCING PAIN, DURING 2016 - the aim was to relieve the pain therapy, the patient returned to clinic for a ALLOWING COMPRESSION THERAPY sufficiently to measure ABPI and to scheduled dressing change. Her pain score enable the patient to wear graduated was much reduced to 3/10. She reported THERAPY high compression bandaging. At the sleeping better and was now able to beginning of therapy, the wound tolerate dressing changes. measured approximately 7.5cm2. The pain continued to improve Along-side Accel-Heal, the wound was during therapy. The wound itself also dressed with a topical honey dressing significantly improved with a reduction in A patient with a venous leg ulcer could not Therapy with Accel-Heal rapidly and highly absorbent secondary dressing wound size and exudate. At the end of the SUMMARY tolerate any compression therapy because relieved the pain, allowing graduated and a support bandage. The peri-wound 12-day therapy the pain was minimal of pain scoring 10/10. compression therapy to be started. skin was protected with barrier cream. and only small dry scabs remained. The wound healed three weeks after During dressing changes the wound was starting Accel-Heal therapy. irrigated with anti-microbial irrigation fluid.

A 50-year-old patient with a history The wound pain caused her to cry with At the end of the 12-day Accel-Heal The patient was so grateful for the BEFORE of recurring venous leg ulcers despite the discomfort, particularly during dressing AFTER therapy, graduated short stretch ‘wonderful result’ and in particular she wearing compression hosiery, presented changes. Various topical cleansers, honey compression bandaging was applied. expressed the delight in achieving a with a very painful ulcer of three-weeks and absorbent dressings with support The aim was to continue short stretch ‘normal and pain free Christmas’, ACCEL-HEAL duration. The patient had previously bandages had been applied. She had ACCEL-HEAL bandaging until good tensile strength which she had been very worried about. suffered from fracture of the right ankle. also had several courses of antibiotics. was obtained in the wound and then She was surprised by the speed of Limb assessment confirmed advanced to measure for compression hosiery recovery and more importantly the venous disease. The patient’s wound was Although graduated compression to prevent recurrence. The wound was reduction in pain being so significant excruciatingly painful with a pain score therapy was considered, the patient completely healed, and the patient was within a few days of therapy. of 10/10 despite taking co-codamol could not tolerate the therapy because discharged with compression hosiery in and pregabalin. of the wound pain. She also could not February, around two months after tolerate the assessment of ankle-brachial Accel-Heal therapy. pressure index (ABPI), although all foot pulses were audible with tri-phasic and bi-phasic sounds.

10 9 8 7 6 5 Figure 1. Wound to right medial malleolus on 15/12/16 Figure 2. Wound to right medial malleolus on 15/12/16 4 3

Pain score (out of 10) score Pain 2 1 PAIN SCORE REDUCED TO 0 1/10 AFTER FROM 10/10 0 3 6 9 12 3 DAYS Day of treatment with Accel-Heal

Figure 3. Commencing Accel-Heal on 15/12/16 Figure 4. Right medial malleolus on 09/02/17. Wound healed

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CASE STUDY TWO REDUCING PAIN, ALLOWING COMPRESSION THERAPY

90-year-old patient sustained a traumatic Therapy with Accel-Heal started in SUMMARY wound resulting in a non-healing venous DURING November and continued for 12 days, leg ulcer which had been present for four along-side standard care with graduated to six months. The wound healed 12 weeks high compression therapy and primary following Accel-Heal therapy. THERAPY dressings as per local protocol.

The patient had a diagnosis The wound measured approximately Two weeks after commencing therapy The wound pain score had reduced to BEFORE of dementia. Limb assessment 24.75 cm2. She was prescribed twice AFTER with Accel-Heal, the wound had halved in 1/10. At week eight, the wound measured demonstrated venous incompetence, weekly dressings with honey and graduated size to approximately 10.25 cm2. Exudate approximately 0.5 cm2 with no pain and with ankle brachial pressure index within high compression bandages. Her pain significantly reduced and the patient now the wound had completely healed within ACCEL-HEAL normal limits. Compression therapy was score was 5/10. ACCEL- HEAL only needed weekly dressing changes. 12 weeks. therefore indicated but had been poorly tolerated due to her pain levels.

10 Wound area (cm2) area Wound 5 WOUND SIZE MORE 0 THAN 0 2 4 6 8 10 12 AFTER 2 WEEKS HALVED Weeks after starting Accel-Heal

Figure 1. Wound to left tibial crest prior to Figure 2. Wound to left tibial crest at week Figure 3. Wound to left tibial crest healed at Accel-Heal on 02/11/17 5 on 08/12/17 week 12

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CASE STUDY THREE KICK-STARTING HEALING IN A PREVIOUSLY STALLED WOUND

A patient with recurrent arterial foot ulcers The wound, which had been present for six Therapy with Accel-Heal began in May Within five days of commencing SUMMARY was experiencing high levels of wound pain. months, healed nine weeks after starting DURING 2013. Accel-Heal was applied along- Accel-Heal therapy, the patient’s pain Therapy with Accel-Heal reduced wound Accel-Heal therapy. side the gel-sheet dressings which were score had reduced to 0/10. The wound bed pain from 8/10, to no pain, within the first 5 changed twice weekly throughout the was much improved, with reductions in days of therapy. THERAPY 12-day Accel-Heal therapy. both size and depth.

A 75-year-old patient presented On presentation, there were two wounds After the 12-day therapy period the The wound continued to progress and BEFORE with recurrent arterial foot ulcers on her present, measuring approximately 6cm2. AFTER wound continued to be managed with complete healing was achieved by the end right foot that had been present for four The wounds were painful with a gel sheet dressings, twice weekly. of July 2013. In August 2013, the patient months in March 2013. She had previously score of 8/10. A gel sheet was applied underwent an angioplasty to help ACCEL-HEAL experienced foot ulcers in 2009 and to re-hydrate the wounds. Although this ACCEL-HEAL prevent recurrence. suffered an MRSA infection. The patient initially reduced the pain to 4/10 within a was a smoker with poor ankle movement, few weeks (by the end of April) there were claw toes and poor mobility who had been no further improvements and the pain self-caring for her wounds with support score had increased back up to 8/10. from her brother and husband who were podiatrists.

0/10 PAIN AFTER SCORE 5 DAYS

Figure 1. Prior to Accel-Heal on right dorsum of foot March 2013 Figure 2. Right dorsum of foot 02/06/13 - 5 days after commencing Figure 3. Right dorsum of foot 11/06/13, following completion of Figure 4. Right dorsum of foot 30/07/13 - Wound healed Accel-Heal Accel-Heal

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CASE STUDY FOUR KICK-STARTING HEALING IN A PREVIOUSLY STALLED WOUND

A patient with a wound of 3-years duration 12-day Accel-Heal therapy commenced The patient found the therapy very SUMMARY was treated with Accel-Heal. After starting DURING in January 2018, alongside standard moist comfortable. An improvement was noted this therapy his wound healed within wound management and graduated high- during the first dressing change, when six weeks. compression bandaging. Dressings were the wound dimensions were reduced to THERAPY changed twice weekly. 0.35cm2 x 1mm deep.

A 57-year male presented with a venous The patient’s wound management Two weeks after commencing therapy with The wound completely healed at week BEFORE leg ulcer which had been present for three was complicated by Type 2 diabetes, AFTER Accel-Heal, the wound was again reduced six and remained healed six weeks post years. The patient was receiving gold neuropathy and hypercholesteremia. to only 0.12cm2 with no depth. From this healing. The patient was ‘very happy’ with standard graduated high compression Past medical history included previous point, only weekly dressing changes the results. ACCEL-HEAL bandaging but despite this, the wound vascular surgery in 2012 and 2017. ACCEL-HEAL were required. had showed no signs of progress. The wound measured approximately 0.8cm2 and 1mm deep. The wound was not painful.

0.8

0.6

0.4

Wound area (cm2) area Wound 0.2

0 WEEK 6 WOUND 0 2 4 6 COMPLETLY Weeks after starting Accel-Heal HEALED

Figure 1. Wound to left lateral malleolus Figure 2. Wound to left lateral malleolus on prior to Accel-Heal on 11/01/18 22/02/18 Wound healed within 6 weeks

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CASE STUDY FIVE KICK-STARTING HEALING IN A PREVIOUSLY STALLED WOUND

A patient with bilateral recurrent venous Following discussion and consent, the Accel-Heal therapy began in SUMMARY leg ulcers, which had been present for DURING patient was prescribed Accel-Heal therapy February 2017 and continued for more than four months was treated with with the aim of reducing wound pain and 12-days. Standard moist wound healing Accel-Heal. Both wounds significantly kick-start wound healing. In view of the and graduated high-compression therapy improved within three months following THERAPY size, depth and condition of the wound, it continued during and following Accel-Heal Accel-Heal therapy. was decided to apply the electrode pads to therapy. Twice weekly dressing changes the left medial wound. continued. The patient changed his own Accel-Heal devices every 48-hours, in line with the instructions provided.

A 75-year-old patient presented with Despite wearing graduated high Two weeks after starting Accel-Heal By the end of March 2017, wound area BEFORE bilateral recurrent venous leg ulcers, compression bandaging for four weeks, AFTER therapy, there was no change to the on the patient’s left leg had significantly despite wearing compression hosiery. there was no improvement noted. He was patient’s pain score, but the patient reduced, now measuring only 1cm2. The The wounds remained unhealed at referred to the vascular team for possible reported that much of his pain was now pain score had also reduced to 2/10. ACCEL-HEAL 4 months. The wound on the left leg vascular surgery, in view of his recurrence. THERAPY due to arthritis of the ankles, rather than Dressing changes could now be reduced wound measured 7cm2 and the wound His pain score was 6/10 despite taking wound-related pain. He was taking regular to once weekly; the wounds continued to on the right leg wound measured 10cm2. regular co-codamol and he was referred to analgesia, following review by the GP. improve. Unfortunately, the patient was the GP for analgesic review. lost to follow-up, so the time to complete healing could not be determined.

WITHIN 12 WEEKS TWO WOUNDS SIGNIFICANTLY IMPROVED

Figure 1. Left medial aspect Figure 2. Right medial aspect on 24/01/17 Figure 3. Left medial wound on 28/03/17 Figure 4. Left medial wound on 09/05/17 Figures 5. Right medial wound on 09/05/17 Figures 6. Right medial wound on 09/05/17 24/01/17 prior to Accel-Heal prior to Accel-Heal accelheal.com accelheal.com 16 17

CASE STUDY SIX IMPROVING DURABILITY OF HEALING IN PATIENTS WITH PREVIOUS RECURRENCE

A patient with a history of a repeatedly No recurrence of this previously The 12-day Accel-Heal therapy was started Along-side Accel-Heal, wounds were SUMMARY recurring venous leg ulcer was treated with challenging wound was observed for DURING with a primary goal of kick-starting wound managed with standard moist wound Accel-Heal. The wound healed 13 weeks at least two years after therapy. healing. A secondary goal was to improve healing and graduated high compression after Accel-Heal therapy. the quality of healing to reduce the risk of bandaging and dressings were changed THERAPY future recurrence. twice weekly.

A 46- year old, self-caring patient with a At presentation, he was suffering from The wound was noted to be completely BEFORE history of repeatedly recurring venous leg depression and was unable to return to AFTER healed within 13 weeks. The wound ulcers presented with a fourth recurring work, seeing “no future” for himself “with remained healed for at least two years after ulcer which had been present for several these recurring wounds”. the Accel-Heal therapy, at which point the ACCEL-HEAL weeks. The wound had recurred despite THERAPY patient was lost to follow up. wearing class 3 compression hosiery. The wound measured approximately 8cm2 and was not painful. The patient had suffered a past fracture to his left tibia and a left deep vein thrombosis following a road traffic accident in 1989 and was unsuitable for venous surgery.

WEEK 13 REMAINED WOUND HEALED COMPLETLY AT LEAST HEALED 2 YEARS

Figure 1. Medial left malleolus on 17/02/13 on start of Accel-Heal Figure 2. Medial left malleolus on 25/03/13. Wound healed

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CASE STUDY SEVEN IMPROVING DURABILITY OF HEALING IN PATIENTS WITH PREVIOUS RECURRENCE

A patient with a fifth recurrence of an ulcer, The rapid wound healing observed after The 12-day Accel-heal therapy The wound was cleansed and debrided SUMMARY whose wounds had never before remained Accel-Heal therapy appeared more DURING was commenced, with the aim to during dressing changes. Within one week healed for more than three months, was durable, with no recurrence of the reduce the pain, and kick-start healing. of therapy with Accel-Heal the pain had treated with Accel-Heal. wound for at least 12 months. A secondary aim was to improve the considerably reduced and the wound was THERAPY quality of healing to reduce the risk clean and advancing. of recurrence. Accel-Heal therapy was applied along-side standard moist wound healing and high compression bandaging.

A 57-year-old patient with a history of In the past, the patient’s wound had The wound completely healed within Although the patient’s wound had BEFORE deep vein thrombosis (DVT) and previous never remained healed for longer than AFTER 3.5 weeks of starting therapy with previously repeatedly broken down within venous surgery presented in September three months, despite his wearing class Accel-Heal, by mid-October. 3 months of healing, this time there was no with a venous leg ulcer of 4 weeks duration. 3 compression hosiery. He stated that he recurrence within 12 months at which point ACCEL-HEAL This was the fifth time that this ulcer “never felt the wound completely healed ACCEL-HEAL the patient was lost to follow up. had recurred. after each recurrence”.

The wound measured approximately 7cm2 and was very painful, with a pain score of 7/10.

WEEK 4 REMAINED WOUND HEALED COMPLETLY AT LEAST HEALED 2 YEARS

Figure 1. Medial left malleolus on 17/09/14 on start of Accel-Heal Figure 2. Medial left malleolus on 08/10/13. Wound healed at 3 ½weeks

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CASE STUDY EIGHT IMPROVING PATIENT QUALITY OF LIFE

A patient with a large, malodorous Exudate and malodour reduced rapidly The patient agreed to Accel Heal therapy in SUMMARY and highly exudative venous leg ulcer after therapy commenced, meaning DURING October 2017 and continued for 12 days, of 15-months duration was treated the patient was confident to once again while standard care continued with high with Accel-Heal. spend time with his family. The wound compression therapy and moist wound healed 12 weeks after commencing THERAPY healing as per local protocol. Accel-Heal therapy.

A 75-year-old patient had a 20-year The patient had previously been Two weeks after starting therapy with The patient was able to see his grandchild, BEFORE history of Parkinson’s disease which treated with several advanced therapies AFTER Accel-Heal, the wound measured 5cm x which was previously prevented because of caused reduced mobility. and topical steroids. Despite this, 6.5cm. Exudate had significantly reduced the malodour. the wound measured approximately with no malodour and required only twice ACCEL-HEAL Limb assessment showed signs of venous 8.5cm x 6cm. Exudate was heavy and THERAPY weekly dressings. disease and normal ankle brachial pressure malodourous, and he was receiving four index, making him a suitable candidate for times weekly dressings. The wound was graduated high compression therapy. not painful.

WEEK 12 WOUND COMPLETLY HEALED

Figure 1. Wound to right lateral aspect on 26/10/17 prior to Figure 2. Wound to right lateral aspect on 07/11/17 at week 2 Figure 3. Wound healed at week 12 Accel-Heal therapy following completion of Accel-Heal

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CASE STUDY NINE IMPROVING PATIENT QUALITY OF LIFE

An elderly patient with a history of venous One wound healed within four weeks and The 12-day Accel-Heal therapy started in Due to the extensive size of the wounds, SUMMARY leg ulcers presented with two ulcers of 7 considerable improvement was noted DURING March. The aims of therapy were to reduce the two electrode pads were applied at weeks duration. to the second wound which went on to the inflammation, pain and exudate and opposite sides of the wound/s, avoiding the completely heal within 38-weeks following expedite healing. risk of exudate saturating the wound due issues with varicose eczema. THERAPY to leg dependency. Standard therapy with Instructions were provided to the patient’s graduated reduced compression continued wife to change the Accel-Heal device during and after the Accel-Heal therapy. every 48-hours and the dressing regime continued three times weekly when the nursing team changed the electrode pads.

An 80-year old patient with a history Wound pain was scored 5/10 despite During April, a great improvement was The patient developed marked varicose BEFORE of venous leg ulcers in 2007 and 2012 taking regular analgesia. The patient was AFTER noted; exudate was decreased and the pain eczema and was prescribed an intensive presented with two recurring ulcers on reluctant to increase up the analgesic score reduced to 4/10 with no pain by the course of topical steroids and emollients. the left inner side of the ankle, extending ladder and alternative means of relieving end of April. The eczema and wounds were completely ACCEL-HEAL extensively to the back of the ankle pain were considered. ACCEL-HEAL healed in December. and back of the leg. The ulcers had One wound became infected and required been present for seven weeks and had Antibiotics had been prescribed following two further courses of antibiotics between The patient was so delighted with the developed spontaneously, despite a positive wound swab. The wound April and June, but the wound did not outcome he wrote a lovely letter - he could wearing class 2 compression hosiery. was dressed two-to-three times deteriorate. The patient could now tolerate not believe the result when previous ulcers Limb assessment identified signs of weekly, with antimicrobial cleansing and graduated high compression therapy. had taken so long to improve. He stated he venous disease. debridement during dressing changes. had a huge improvement to his quality of Graduated reduced compression life with no pain and no wet leaking legs. bandages (approximately 20 mmHg at the ankle) were used between dressing changes but high compression therapy was not tolerated. 0/10 PAIN AFTER SCORE 4 WEEKS

Figure 1. Left medial aspect 25/02/16 Figure 2. Left posterior aspect 25/02/16 Figure 3. Left medial aspect on 07/04/16 Figure 4. Left medial aspect 12/01/17. Wounds healed

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CASE STUDY TEN IMPROVING PATIENT QUALITY OF LIFE

A 56-year-old patient developed non- Therapy with Accel-Heal relieved pain The patient agreed to try Accel-Heal Within one week of commencing the SUMMARY healing wounds following chicken pox. and kick-started healing; the wound was DURING therapy in November 2013 in view of Accel-Heal therapy, the pain score The patient became very frustrated healed within five months after starting non-progression, pain level and persistent was halved to 4/10. and down about the lack of progress, Accel-Heal therapy, improving the patient’s infection. The electrode pads were applied his wounds having been present for mental health. THERAPY to the tibial crest wounds, alongside 15 months. Wounds were very painful anti-microbial dressings which were despite analgesia and antimicrobial changed twice weekly during therapy. dressing being used.

The patient, who was the main carer Therapy commenced with topical By late January 2014, 2 months following The patient’s mental health was noted BEFORE for his mother, developed chicken pox in anti-microbial cleansing solutions and AFTER therapy, there was significant improvement to have improved considerably and by August 2012. He presented in April 2013, dressings twice weekly. The patient would in the status of the wound. Pain was now April, four months after Accel-Heal, all with two wounds to his right leg, which regularly attend the clinic but was often reduced to 2/10. the wounds were healed. The patient was ACCEL-HEAL had developed as a result of the infection. withdrawn, sometimes verbally aggressive ACCEL-HEAL absolutely delighted with the outcome on He had a past medical history of fracture and frustrated with the lack of progress his previously non-progressing wounds. of the right tibia and fibula with insertion with his wounds. He declined support of a plate; previous radiology had excluded for his mother, anti-depressants and osteomyletitis. Venous duplex revealed referral to the pain clinic and initially evidence of some venous incompetence declined Accel-Heal therapy for some but no deep vein thrombosis. time. The wound became regularly infected and the pain score increased to Despite being suitable for venous 8/10 despite antibiotics and analgesia. surgery, this was declined. The patient reported wound pain of 6/10 for which PAIN he was prescribed co-codamol. He was unable to tolerate any compression or SCORE support bandage. AFTER HALVED 1 WEEK

Figure 1. Right tibial crest and maleolus 08/04/13 Figure 2. Right maleolus on 08/04/13 Figure 3. Right tibial crest on 04/11/13 prior Figure 4. Right maleolus on 31/03/14 - Figure 5. Right tibial crest on 31/03/14 – to commencing Accel-Heal Wound healed wounds healed

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accelheal.com accelheal.com REFERENCES

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Item Size Product code PIP code NHS code 1 x Accel-Heal® therapy 7cm x 4cm x 2cm K560-6 373-0942 ELZ752 (6 x 48 hour units)

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