No matter how a wound comes about — by pressure, injury, or venous insufficiency — a non-healing wound becomes more than a medical problem. As a para with a T11 SCI for 57 years, I have had a number of wound care challenges, mostly on my ankle bones (right and left malleolus), both legs, and my ischial areas.
My favorite wound care doctor, Dr. Bruce Ruben, explained to me that non-healing wounds, which he specializes in treating, need five essentials to heal — freedom from infection, freedom from pressure, freedom from edema, sufficient blood flow, and proper nutrition. Each one is critical to the healing process, and a non-healing wound needs all five working together to make real progress.
I was fortunate to have Dr. Ruben as my long-distance wound care advisor about 10 years ago. Because he owned and operated an accessible wound care clinic — complete with its own infusion center, hyperbaric oxygen chambers, and roll-in showers — I featured him in an issue of New Mobility magazine. Most of what I now know about wound care came from phone conversations with him. He practiced in Michigan, and I live in Oregon.
When a large wound showed up on the outside of my right calf (from being exhausted one night and failing to turn myself during a 10-hour period of “dead” sleep), I called him. The wound had grown larger, deeper, refused to heal, and cellulitis had set in. It just happened that he was planning a vacation trip to Oregon, so we met face to face for the first time on my front porch. Talk about a long-distance home call!
He spent three hours with me, took a comprehensive medical history that included not only my wound history, but anything related to my health, examined my leg, went over my meds with me and promised to send a plan of treatment. When I asked how much it would cost, he refused to accept any payment. A week later, I had his treatment plan in hand.
When I called him, I was being treated with a wound vac, but the wound was not healing, and my skin kept getting irritated. Dr. Ruben’s plan included daily low-dose prophylactic use of a well-known antibiotic, a daily protein intake of 1.0 to 1.25 grams/per kilo of body weight, and Unna boot therapy. First, though, he concluded that my blood circulation, although impaired, was sufficient (a noninvasive ankle-brachial index test — ABI — established this). He also made me promise to keep my foot and leg elevated as much as possible during the day, protect it from pressure at night, and coordinate his plan with my local vascular surgeon.
I noticed progress immediately. An Unna “boot” is actually a wrap consisting of a roll of zinc oxide-impregnated gauze applied to the lower leg, starting at the base of the toes and wrapping gently with a spiral method that overlaps 50% all the way to just below the knee. On top of that comes a protective wrap of Kerlix, again applied with neutral pressure, followed by an elastic bandage wrapped with moderate pressure and a 50% overlap. An Unna boot eliminates swelling (edema), promotes healing and skin integrity with zinc, protects the wound from trauma and allows freedom of movement.
It’s important to have minimal or no edema before applying it. Also, if toes and foot turn purplish or swell, discontinue the wrap. Each new wrap can be worn up to seven days before changing, but my home care nurse changed mine three times a week for the first week just to keep a close watch on how it was working and teach me and my wife how to change it ourselves. It worked so well that I was able to fly from Oregon to Austin, Texas, for an important conference — a three-day trip with no wrap changes — elevating my foot in my hotel room each day.
Not only did Unna boot therapy heal my non-healing wound, but the concept of a wrap has also become an important part of my daily routine. I no longer use compression socks. Each morning I pull on a mild or zero compression, knee-high Tubigrip sock and cover that with a moderate compression reusable elastic bandage. No more zinc-impregnated gauze, no more edema, no more wounds. Also, it is an inexpensive option.
As always, be certain to consult a doctor or wound care nurse before trying an Unna boot wrap. It is not for everyone. It is best to do it under the care of a medical professional. Several YouTube videos showing how to wrap an Unna boot (there are two different methods) are available online. Also, here is some suggested reading:
https://newmobility.com/unna-boot-compression/
https://inoviavein.com/unna-boots-for-wounds-venous-stasis-ulcers/
Tim Gilmer graduated from UCLA in the late-1960’s, added an M.A. from the Southern Oregon University in 1977, taught writing classes in Portland for 12 years, then embarked on a writing career. After becoming an Oregon Literary Fellow, he went on to join New Mobility magazine in 2000 and edited the magazine for 18 years. He has published upwards of 100 articles, 200 columns, occasional movie reviews and essays. He and Sam, his wife and companion of 47 years, also own and operate an organic farm south of Portland, where they live with their daughter and son-in-law, four grandsons, and a resident barn owl. An excerpt from a memoir about his early post-SCI years, as part of a compendium of his writing over the past 30 years, can be read at his website, All You Need.