Acute Wound with Varicose Vein in Rural Setting: The Challenge and Importance of Comorbidity Management

Abstract

Background: Acute wound healing with comorbidities, such as a varicose vein, may be impaired and result in prolonged healing and unsightly scar if comorbidity identification and management are not done properly. We aimed to present the alternative comorbidity diagnosis and treatment for better outcome in rural setting. Case description: A 59-year-old woman was admitted to the ED with an open wound on the dorsolateral side of her left foot with comorbidity of uncontrolled hypertension and varicose vein. After wound closure with simple suture, the Perthes and Brodie-Trendelenburg tests were done which indicated insufficiency of perforator vein grade C3. Elastic bandage and physical activity restriction along with routine wound care and hypertension treatment were administrated with attention on wound exudate and pain level. On the 14th day, a day after the patient had prolonged standing, the wound was heavily macerated; it resolved to secondary healing and achieved full closure on the 53rd day with normal physiologic function and esthetically acceptable scar. Conclusion: The challenges we encountered in this case consisted of the limitation in diagnostic modality, the patient’s non-adherence to the treatment protocol, and the lack of wound dressing choice due to limitations in the rural setting. The combination of excellent wound care, comorbidity management supported by appropriate diagnostic and treatment modality, and patient’s adherence to treatment protocol are crucial for functional and esthetic wound healing. Despite challenges in a rural setting, achieving optimal wound healing may still be possible by utilizing alternative diagnostic and treatment choices, together with effective education.