Reclaiming Mobility: A Case of Refractory Bilateral VLUs Reversed Through Single-Time Debridement

This article presents the case of a 58-year-old veteran who lived with recurrent bilateral venous leg ulcers caused by deep vein thrombosis.

 His condition was marked by:

• Severe pain requiring oral morphine before dressing changes
• Reduced mobility which resulted in him experiencing falls and living in a microenvironment in his kitchen
• Hospitalisation after an overdose of analgesia, cycle of recurrent infections requiring antibiotics
• Heavy growth of Staphylococcus aureus and mixed coliforms

Despite this, he volunteered daily with the homeless. He stood for hours each day in service to others at a time when standing was painful and progress felt impossible. His story is one of resilience, but also a reminder of reassessing chronic wound care treatment. It underscores the complexity of long-term wound care and invites us to redefine what healing can look like with the right intervention, at the right time.

Clinical Summary

• Patient: 58-year-old man with a 6.5-year history of bilateral VLUs
• Etiology: Post-DVT venous insufficiency
• Holistic Impact: Pain, anxiety, depression, social isolation
• Intervention: One-time chemical debridement agent DEBRICHEM® applied in December 2021
• Antibiotic Use: Zero prescriptions in the 5 months post-application (vs. every 3 months previously)

Clinical Progression

• Granulation improved to >90% by week 8
• Slough reduced from 40% to 10% by week 8
• Exudate dropped from high to low-to-moderate by week 16
• Epithelialising edges by week 16
• No clinical signs of infection throughout follow-up
• Reduced pain, no malodour, no need for morphine or co-codamol beyond baseline

A Long Road with Venous Leg Ulcers

The patient was first diagnosed with bilateral venous leg ulcers (VLUs) in 2015 at a complex wound clinic led by a tissue viability team. The ulcers were linked to post-thrombotic changes from DVT.

Medical History

His medical history included anaemia, coeliac disease, lupus-anticoagulant positivity, and osteopenia, adding to the clinical challenges of care.

Treatments Tried

Over the years, his ulcers were managed using:

• Honey-based dressings
• Hydrofiber (with and without silver)
• Metronidazole gel
• Silver sulfadiazine
• Superabsorbent dressings
• Zinc Paste and emollients
• All secured with compression therapy using either two-layer bandages or Velcro wraps

Despite regular weekly clinic visits and vascular reviews, the ulcers fluctuated in response. His left leg healed temporarily in 2016 but relapsed in 2017. That year marked a significant decline in his condition, severe pain restricted his movement, he became socially isolated, and in April 2017, he was admitted to hospital following an overdose on analgesia.

A cycle of recurrent wound infections began in 2018, with antibiotic courses prescribed approximately every three months. Although his left leg eventually healed in 2020, the right ulcer remained static.

The Wound at Presentation

On December 2, 2021, he was assessed at a complex wound clinic. His right leg ulcer measured 10.5 x 8.0 cm. The wound bed was 60% very dark red, purulent and friable tissue, and 40% covered with yellow slough. Swab results indicated heavy colonisation with Staphylococcus aureus and mixed coliforms, and he had been prescribed antibiotics approximately every three months due to recurrent infections.

The edges were dark purple, with maceration of the periwound skin. There was a high level of serosanguinous exudate and the wound had shown no meaningful progress in a year despite antimicrobial dressings and systemic antibiotics.

This time, his treatment before the intervention included:

• Full compression bandages
• Steroid cream (for varicose eczema around the wound)
• Superabsorbent pads (for moderate-to-high exudate)
• 50:50 white paraffin ointment (to moisturise the entire leg)
• Zinc paste (for dry, itchy skin around heel and ankle)

Between appointments, he redressed the wound himself using Velcro wraps instead of compression bandages, due to lack of trained practice nurses at his GP surgery. These wraps were:

• Easier to self-apply, but
• Often too loose, especially at the top
• Removed daily for moisturisation, disrupting compression consistency

His quality of life was still significantly impacted. He was volunteering daily, spending long hours on his feet, yet he lived in discomfort and needed to redress the wound himself between appointments, meaning compression was inconsistently applied and hard to maintain. He took citalopram, warfarin, and co-codamol regularly. His quality of life was visibly affected, and the wound showed no meaningful signs of healing.

This was when the care team decided to consider something new.

A Change in Approach: One-Time Chemical Debridement

With a chronic, non-progressing wound and recurring signs of local infection, the team considered introducing a single-use chemical debridement agent: DEBRICHEM®. The goal: eliminate the suspected biofilm, infection, and devitalised tissue.

 The procedure involved:

1. Thorough cleansing of the wound
2. Application of the chemical debridement agent for 60 seconds to the wound and periwound area
3. Rinsing with high-flow sterile saline
4. Returning to the usual dressing regimen: non-adherent contact layer, superabsorbent pads, and compression therapy, was maintained.

What Is DEBRICHEM®?

DEBRICHEM® is a CE-marked Class IIb medical device designed for chemical debridement of chronic wounds. It eliminates devitalized tissue, infection, and biofilm from chronic wounds in just 60 seconds creating a clean and stable wound bed, while preserving healthy skin. Used across etiologies, it is an advanced wound bed preparation tool that helps accelerate granulation, pushing the wounds towards healing.

How DEBRICHEM® Works?

DEBRICHEM® works by coming in contact with water in the biofilm, releasing an impressive amount of energy - approximately 1500 kJ/mol. This energy denatures and carbonizes the biofilm’s extracellular polymeric substance (EPS), breaking down its structure and destroying its contents. Over time, the denatured and carbonized material detaches from the wound surface. As it remains in place initially, granulation tissue begins to form underneath, creating the foundation for healing. By eliminating the biofilm barrier, DEBRICHEM® facilitates granulation and reopens the natural path to wound recovery.

Follow-Up and Observations Over 16 Weeks

The patient returned weekly for review. His progress was marked and steady:

• Week 1: Central desiccation with surrounding healthy granulation. Surrounding skin appeared healthier. No evidence of biofilm, infection, or systemic concern.
• Week 2: Slough had reduced to a central area only. Edges showed minimal rolling.
• Week 6: Granulation covered 70% of the wound bed. Slough reduced to 30%. Edges were flat. Exudate was moderate.
• Week 8: Granulation increased to 90%, with only 10% residual slough.
• Weeks 10–14: The wound continued to maintain a healthier appearance, though a thin layer of slough persisted at times.
• Week 16: Epithelialisation began at the wound edges, with low-to-moderate exudate levels.

Notably, no systemic antibiotics were required throughout the 5-month follow-up, marking a significant shift in his management, considering his prior dependency on quarterly antibiotic cycles.

Interpreting Progress

The wound began showing signs of forward progression for the first time. The quality of the tissue, the reduced need for antibiotics, and the absence of infection or biofilm were meaningful outcomes

• Pain decreased dramatically after the intervention
• Malodour resolved
• Exudate levels reduced from high to moderate or low
• Healthy Granulation reached the surface
• Epithelial edges began forming
• No antibiotics were needed
• No reinfection observed

⏱️ For Busy Clinicians: Why This Case Matters

When treating long-standing VLUs, especially those that have stagnated despite best-practice compression and antimicrobial dressing regimens, the risk of slipping into an infection-antibiotic cycle is high.

This case demonstrates:

• A single, short intervention that helped reset the wound bed without systemic antibiotics.
• A visible reduction in slough and biofilm indicators within 2 weeks.
• Sustained improvements in granulation, pain, and periwound skin health without escalation of care.
• The value of adjunctive wound bed preparation, even in long-term community-managed ulcers.

For healthcare professionals managing chronic wounds, the burden of care can feel never-ending. But as this patient’s case shows, a single intervention can turn the tide. DEBRICHEM® is not a cure-all, but for the right patient, at the right time, it can be the reset button that reignites progress.

If you’re a clinician, wound care specialist, or medical professional interested in learning more about how DEBRICHEM® fits into real-world practice, visit

Or reach out to us directly to discuss whether DEBRICHEM® could help your patients move forward again.

🔬 Backed by case studies.

💬 Supported by patient stories.

🌍 Built for real-life healing.

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