Topical Timolol for Recalcitrant Wounds

Abstract

Patient 1 A woman in her 80s with a history of venous insufficiency based on clinical presentation and vascular studies presentedwithmultiplepainfululcerationsonthebilateral ankles. She developed wounds in 1972 with subsequent trauma that led to repetitive skin breakdown.Her currentwounds began 1 year ago. The patient was initially treated with multilayered elastic compression bandages (Profore; Smith & Nephew), which were changed weekly, and various foam dressings (Allevyn; Smith & Nephew; Mepilex Ag; Molnlycke Health Care).When herwound failed to heal, adjuvant therapies, including serial applications of porcine small intestine submucosa (Oasis;HealthpointBiotherapeutics), bilayered living skin equivalent (Apligraf; Organogenesis) and an autologous splitthickness graft from the thighwere used but did not result in complete closure. After 6months, thewoundwas 3.2 cm2 and a β2-adrenergic receptor (B2AR) antagonist, topical timolol, 0.5% (Timoptic;AtonPharma),was instilled, 1dropevery2 cm of wound edge weekly, then covered with silicone foam and 3-layer compression. All wounds, including her target ulcer, were fully epithelialized after 8 weeks of treatment, and the patient was prescribed a compression apparatus (JuxtaCure; CircAid Medical Products) to prevent recurrence.