> Clinical trials to date
> Initial publication -Phlebology
> Management of foot and leg ulcers
> A randomised controlled trial: Kerraboot vs Allevyn^®
> Kerraboot – benefits of treatment
> Beyond lower limb ulcers:
> surgical debridement and skin grafting
> Case studies

Case studies
1. I. Wilson, S Butterly. Kerraboot® and its use in a patient with multiple lower limb ulcers.


2. J Smith. Management of a persistent plantar ulcer with Kerraboot®.


3. D Wilson. Kerraboot® - A genuine alternative for the management of diabetic foot ulcers.


4. SGE Barker et al. Stimulating granulation tissue: use of Kerraboot®


5. A Walker. Kerraboot® – An innovative solution to the management of long-term ulcers


6. A Gale. Treatment of a non-healing scar 


7. J Edwards. Clinical evaluation into the use of Kerraboot® in foot burns.

Kerraboot has been used to manage cases where amputation was being considered for the patient.

8. Healing of neuropathic foot ulcer using a novel ‘Wound Boot’ (Kerraboot)
A 67-year-old-man with poorly controlled type 2 diabetes who developed ulceration of both heals during a prolonged hospital admission for septicaemia. Infection in the left heel had spread and ulceration was deteriorating. Kerraboot was used to facilitate wound healing by promoting the growth of granulation tissue, thus circumventing the need for amputation.

9. Kerraboot and its use in a patient with multiple lower limb ulcers
An 81-year-old lady was admitted to University Hospital Birmingham. She presented with confusion secondary to sepsis, constipation, dehydration, peripheral vascular disease, bilateral heel ulcers & urinary incontinence. She was recommended for below knee amputation of the left leg due to failure of earlier popliteal by-pass, however the patient and her family rejected this option and so Kerraboot was applied. The ulcers responded remarkably well to treatment and after 8 weeks all had decreased in size. The need for amputation was, once again, avoided.

10. Stimulating granulation tissue in chronic non-healing wounds:
the use of Kerraboot
A 74 year-old lady presented with 3 coalescing ulcers persisting around the right ankle. She had a 25-year history of venous disease and multiple chronic ulcers affecting her lower limbs, but no history of diabetes or hypertension. After 4 months of standard four-layer compression bandaging the ulcers had increased in size. Ulcer management was moved to Kerraboot, which was changed daily for two weeks to promote the growth of granulation tissue. Split-thickness skin grafting was placed, with 100% take to complete healing of the ulcers.

11. Stimulating granulation tissue in chronic non-healing wounds:
the use of Kerraboot
A 78 year-old Asian gentleman presented with a chronic ulcer on the sole of the right foot, extending between the plantar surface of the fourth and fifth metatarsal heads. The patient, a former smoker, was in good health with no history of diabetes or hypertension. The ulcer was heavily infected and intravenous antibiotics were given. Regardless of this, and debridement of the ulcer, no signs of healing were visible. Osteomyelitis was confirmed by plain X-ray. A ray amputation of the third, fourth and fifth toes was performed. Histological examination confirmed a well-differentiated squamous cell carcinoma. Post-operatively the right foot was positioned in Kerraboot for two weeks to promote rapid growth of granulation tissue at the open amputation site. Split-thickness skin grafting was successful at the first attempt.

12. Nursing a Patient with Frostbite
A 36-year old male with a past history of psychiatric disease was admitted to hospital via A & E with a necrotic right foot involving the dorsum, plantar aspect, heel and toes. He was diagnosed with frostbite and admitted to hospital for surgical debridement or even amputation depending on the severity of the injury.

The right foot had 100% necrotic tissue present to the plantar aspect of the foot. The great toe and subsequent 3 toes were hard and 100% necrotic. The heel blister was approximately 8cm x 8cm with 80% necrotic tissue and 20% slough present. There was a blister covering the dorsum of the foot, which was filled with blood stained fluid. The grade of wound was equivalent to a third degree thermal burn. Also of concern were the offensive odour, pain and levels of exudate. Previous treatment, a silicone non-adherent dressing and a simple dressing pad with orthopaedic wool bandage to secure, failed to manage the exudate effectively and was adding to the problem associated with odour.

One month after starting treatment with Kerraboot the necrosis to the toes began to lift, the plantar surface of the foot was granulating and the blister to the heel now had 100% granulation tissue present. The patient returned home and was seen as an outpatient, still with Kerraboot, the following month and he had 100% granulation tissue present to the dorsum of foot, heel and the great toe. The 1st 2nd and 3rd toes had small amounts of necrotic tissue present but this was separating to reveal granulation tissue underneath. The patient found the Kerraboot comfortable to wear, was convenient, reduced pain on dressing change wound odour was managed effectively using this treatment.

13. Limb salvage using Kerraboot
This case study focuses on the use of Kerraboot to treat an extensive, chronic heel ulcer in a 42-year old, type II diabetic female patient, with advanced peripheral arterial disease and neuropathy. She had previously had a below knee amputation of her left leg.

Previously, partial thickness skin grafting of the right heel had twice failed to achieve wound closure, despite a patent arterial bypass graft. Following debridement, Kerraboot was applied around the lower leg and replaced once daily. Improvement was noted after three weeks of therapy and at six weeks, the heel ulcer was significantly smaller and the glued heel flap had remained closed. Kerraboot dressings were continued with on an out-patient basis, applied straightforwardly by her husband, allowing the patient to return home with Kerraboot to undertake self-management of the ulcer. At eight months, the heel ulcer had healed completely preventing the need for amputation.

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14. The non-pressurised boot dressing: an alternative for use
in managing diabetic foot ulceration
This case study evaluates the efficacy of Kerraboot as a genuine alternative to ‘traditional’ methods of wound dressing in the management of multiple diabetic neuropathic foot ulcers on a patient with significant medical and social complications.

A 76-year-old, bed bound, lady developed multiple necrotic ulcers over the right heel and ankle during the application of a below knee plaster cast for the treatment of a tibial fracture. Previously her ulcers were managed by means of daily dressing changes which consisted of the following: 50/50 emollient to surrounding skin, Trimovate cream to irritated skin, Aquacel Ag, Allevyn (x2), Allevyn Heel, Lantor formflex padding and Texband wrap. Podiatry consultation time was 1 hour per visit and district nurse time was 40 minutes.

During 8 months of daily (and on occasion, twice daily) treatment from district nursing and a fortnightly review at the multidisciplinary diabetic foot clinic, progress was slow, consultation times were long, dressings were extensive and marked deterioration of surrounding skin was noted. After 8 months, treatment was switched to Kerraboot which was changed daily.

After just 10 daily applications of the Kerraboot, there was a significant improvement noted in the quality of epithelial and granulation tissue, as well as the condition of the surrounding skin. Removal and application of the boot reduced consultation times by more than 80%. Patient and family were delighted and the heel and lateral side of the ankle healed within 4 months from initiation of Kerraboot treatment.

15. Kerraboot – an innovative solution to the management of long-term ulcers
This case study discusses the use of Kerraboot in the management of long term ulcers of mixed aetiology, in a patient for whom skin maceration was a significant problem due to fragile skin and the high levels of exudate produced by the ulcers.

A diabetic, MRSA positive, female patient, aged 84, presented with multiple, superficial, chronic non-healing ulcers of four years duration. There were 18 ulcers, of mixed aetiology; arterial and venous, in total. Previously, treatment comprised of 3 layer (reduced compression) bandages for four years, and several types of dressings were used during this time including honey, paste bandages and foam dressings. During this 4 year period the patient was admitted to hospital 5 times with an average length of stay of 6 weeks. Admissions were ulcer-related, either chronic infection requiring IV antibiotics and/or unmanageably high exudates levels. In addition there were 4 cottage hospital admissions, with a 6-8 week stay, again for ulcer management. Following discharge from cottage hospital the skin was found to be very frail, tight and shiny. This, in combination with the high levels of exudates, resulted in her skin being frequently macerated and the satellite ulcers breaking down.

Since February 2005 the patient had been placed in a nursing home to overcome the problems associated with age and living alone, notably recurrent falls and reduced mobility. It was in this setting in May 2005 that ulcer management was moved to Kerraboot. Kerraboot was changed daily for the first fortnight and then changed every other day. After just 3 weeks a significant improvement was noted, in particular the ulcers had decreased in size, healthy granulation tissue was visible and the skin appeared much healthier and stronger. Improvement continued with each visit and Kerraboot was discontinued after 3 months when the ulcers were almost healed.