Granulox
®
haemoglobin spray
Case report
3
This 63-year-old male had severe
deformities caused by rheumatoid
arthritis affecting both his hands
and feet. As well as smoking
between 5 and 20 cigarettes per
day, he also experienced episodes
of anxiety and was taking steroids
for his rheumatoid arthritis. He
walked with the aid of a wheel-
based walking frame and had high
cholesterol and hypertension.
The patient was seen by a vascular
consultant and a narrowing of the
tibial artery below the right knee
was diagnosed. This had led to the
development of two large ulcers on
the apex and side of the right big toe
(hallux). The wound on the medial
side of the toe measured 14x9mm,
while the wound on the apex of the
toe measured 6x9mm. The wound
beds contained a thin layer of 100%
creamy adherent slough, but there
was no necrosis or maceration.
The patient was being seen twice-
weekly and various dressings had
been tried, including Activon
®
Tulle
(Advancis Medical); UrgoClean
®
(Urgo Medical); Iodoflex; and
Inadine — all in combination with
Activheal Foam.
However, there were a number of
problems during these dressing
combinations, including maceration
and pain on removal.
Starting on Granulox
®
It was decided to start the patient
on Granulox on 24 March, 2014.
Granulox was chosen due to the
ischaemic nature of the wounds,
which it was felt might benefit from
the oxygen-donating properties
of the product. Also, the patient
was experiencing a lot of pain at
dressing removal and when the
wounds were being cleansed with
saline. The team had been told by
other patients that Granulox had
reduced their pain levels.
After a couple of weeks’ treatment
with Granulox, the creamy adherent
slough in the wound beds began to
dry up, making it possible to gently
debride it with a scalpel (
Figures 1
and
2
). The patient reported less
pain in the wound and was sleeping
better. There was also no odour
from the wounds.
Wound closure achieved
Both wounds eventually achieved
closures within 12 weeks. The
wound on the apex of the toe
resolved on 28 July, 2014 after a
total of 34 applications of Granulox;
the other ulcer was resolved on
27 June after 27 applications. In
both cases, the ulcer cavity was
completely filled and a thin layer
of callus had formed, which once
removed, revealed healthy fresh
epidermis and an absence
of scarring.
Figure 2.
On 12 June, 2014, the wounds have
decreased in size and exhibit 100%
granulation rather than a thin layer of
creamy adherent slough.
Figure 3.
Wounds at 7 August, 2014 — one week
after stopping Granulox, the ulcers
remained resolved and the patient was
applying emollient cream daily.
Figure 1.
The wounds on 10 April, 2014, two-and-
a-half weeks after starting Granulox.
4
This patient’s quality of life
significantly improved when Granulox
promoted the healing of two large ulcers
on his foot, which had been causing
considerable pain. Previous dressings
used had compounded his condition by
causing maceration to the periwound
skin and pain at dressing change.
