This case study describes an 80-year-old woman with atypical venous ulcers that were resistant to various treatments including electrostimulation, negative pressure therapy, and skin grafting. Application of a TLC-NOSF dressing along with venous compression stimulated healing, with the ulcers fully healed within 6 weeks. The dressing promoted granulation tissue growth and re-epithelialization over successive applications where other treatments had failed. This case suggests that TLC-NOSF dressings may effectively treat difficult-to-heal venous ulcers when combined with compression therapy.

1. MANAGEMENT OF AN ATYPICAL VASCULAR
ULCER WITH TLC-NOSF DRESSINGS*
M. NOU, A. KHAU VAN KIEN, T. BEHAR, D. LABAU, C. ZAPPULLA, S. MESTRE-GODIN
J.P. LAROCHE and I. QUÉRÉ (1)
M. MARTIN (2)
(1) Vascular Medicine, Hôpital Saint Eloi, CHU de Montpellier, Montpellier, France
(2) Laboratoires URGO, Chenôve, France
*Brand name: the TLC-NOSF dressing is UrgoStart®

2. 80 year-old woman presenting three ulcers for the past two months, located on the
external malleolus and the top of the left foot and having developed spontaneously.
History: varicose disease, necrotic angiodermatitis, pulmonary embolism, depression
and hip replacement.
Clinical aspects: good general condition,
no fever. Suspended, round ulcers that are
not very painful, slough 95%, necrotic edges
on one of the ulcers 5%, granulation tissue 0%,
epithelialisation 0%, very inflammatory halo,
low exuding.
CASE STUDY

3. Paraclinical aspects: ABI = 1.2, the arterial ultrasound and TCPO2 are normal, the
venous ultrasound reveals moderate incontinence of the left small saphenous vein.
Diagnostic hypotheses: secondarily infected venous ulcers or necrotic angiodermatitis.
Treatment: desloughing using hydrogel then
electrostimulation for 3 weeks.
Disappointing result: slough 100%,
necrosis 0%, granulation tissue 0%,
epithelialisation 0%.
CASE STUDY

4. Surgical desloughing and
introduction of negative pressure
therapy (NPT) for 3 weeks.
Development of purpuric lesions and
persistence of pain.
Necrosis 0%, slough 20%, granulation
tissue 80%, epithelialisation 0%.
CASE STUDY

5. We suspected cutaneous vasculitis and performed a skin biopsy, which confirmed stasis
dermatitis compatible with a secondarily infected venous ulcer.
Treatment included application of venous compression using multilayer bandages and
antibiotic therapy.
Subsequently, buried chip skin grafting
was performed, but the result was
disappointing since only 3 grafts took
and the ulcers had not improved for
several weeks and had never reduced
in size throughout the hospitalisation period.
Introduction of TLC-NOSF dressing* on the day of the patient’s discharge
from hospital and discontinuation of antibiotics.
CASE STUDY
*Brand name: the TLC-NOSF dressing is UrgoStart®

6. Healing course under TLC-NOSF dressing*
After 3 weeks of treatment, we observed a
highly satisfactory result: necrosis 0%, slough
0%, granulation tissue 50% and epithelialisation
50%.
Venous compression was maintained
throughout the duration of treatment with TLC-
NOSF dressing*.
6 weeks after the patient’s discharge from
hospital, the ulcer had healed.
CASE STUDY
*Brand name: the TLC-NOSF dressing is UrgoStart®

7. This patient presented atypical venous ulcers, initially leading us to suspect necrotic
angiodermatitis then cutaneous vasculitis.
Biopsy of the ulcer confirmed the venous aetiology, but successive treatments by
electrostimulation then NPT did not lead to any improvement in the appearance of the
wound. In addition, buried chip skin grafting performed following surgical desloughing,
combined with venous compression, also failed.
The application of a TLC-NOSF dressing*, combined with venous compression using
multilayer bandages, stimulated healing, with recovery obtained in 6 weeks.
CONCLUSION
*Brand name: the TLC-NOSF dressing is UrgoStart®