Any advice will be greatly appreciated.
Thank you!

Please see example of provider’s note.

SUBJECTIVE: The patient is presenting here to re-examine him after one week and 3 days utilization of an Apligraf to the left lower extremity, due to slow healing, chronic venous stasis ulcers. The patient is a diabetic. We have tried multiple conservative therapies on this patient from wet-to-dry dressings, to Unna boots, to Profore, Oasis grafting. We are looking into getting him some compression-type trousers for him to utilize twice daily to reduce swelling. This has been going on for over a year now and he is here for evaluation.

OBSERVATION: Removal of the dressing reveals almost complete healing on the right lower extremity. He has some dry skin noted but no drainage, no ulcerations. On the left lower extremity, again, there are ulcers measuring 10 x 7 cm and one 3 x 7 cm. The Apligraf is still incorporated in some of the ulcer areas dorsally but most of it has dissolved into the wound. He has interesting dermatological raising of granulation tissue and biofilm. We were able to débride this utilizing a sterile saline sponge soaked in saline and were able to rub this off. Bleeding was noted, copious, with 2 packages of Kerlix filled, but we were able to remove down to granulation tissue and into the wound bed. There was no purulence. No sinus tract. No pungent odor. His vascular and neurological exams are unchanged from our last visits. Again, the duration of the ulcer has been for multiple weeks, up to over a year.

ASSESSMENT:
1. Diabetes mellitus.
2. Venous stasis ulcers.
3. Edema.

PLAN: At this time, we were to use the PuraPly AM. Before applying this, we cleansed the wound and removed all the exudate and there was no infection. The bleeding was controlled. Again the ulcers measured, the width and depth was shallow, it measured 10 x 7 and 3 x 7. This is an initial application of the PuraPly AM. After applying this, we applied the Profore with the antibacterial sheet first, and then the Profore. Again, we are choosing this PuraPly AM to manage the biofilm and the bio burden that this patient has had for some time. Again, the patient will keep this dry and intact, try to minimize his walking and elevation. On the right lower extremity, we cleansed the eczema and the dry skin and applied urea 10% lotion and an Ace wrap. He can change this daily, applying the lotion and Ace wrap. I will have the nurse reevaluate this patient in 1 week and I will reevaluate this patient a week from Tuesday. If any problems arise, he will contact us.

ADDENDUM: The wounds measured 11 x 9 on the front and anterior aspect of the left lower extremity, 4 x 4 on the inside of the leg and the back of the ankle was 3 x 3 and also on the anterior aspect of the leg, 2.5 x 3. We applied the PuraPly directly to the wound and moistened it with sterile saline. We applied Adaptic dressing over the top and then followed this with the Profore.