Andrew Holmes Jr.
A chronic wound on his leg was gradually eroding away at Andrew Holmes Jr.’s quality of life over the course of many years. His wound caused him significant and constant pain that could only be mitigated by Tylenol and a prescription for oxycodone. Due to the location of the wound, Holmes had limited mobility and everyday activities like driving became increasingly difficult. Over time, Holmes eventually stopped trying and depended on his wife to drive him to and from his doctors’ appointments.
Not only was his chronic wound affecting his own life, but it started to affect those closest to him. During a family vacation with his wife and daughter, Holmes was forced to spend the majority of the vacation in their hotel room due to the pain.
“I couldn’t walk and I knew I was slowing them down,” said Holmes. “So I just went back to the room and sat there until the trip was over. It just put a damper on everything.”
Holmes turned to the care team at Penn Wound Care and Hyperbaric Medicine at Chester County Hospital, and they searched for a solution until they found one that changed his life.
The Start of His Wound-Care Journey
The trouble began for Holmes one day in 2007, when he was 50 years old. While exercising on an elliptical machine, his right calf suddenly began throbbing. He ended his workout, thinking he strained a muscle, and planned to pick back up the next day. However, the next day he was unable to put any weight on his right leg, and over the course of 24 hours, his calf had become noticeably swollen and warm to the touch.
An ultrasound revealed that Holmes had a blood clot in his calf, for which he promptly received treatment. Soon after, though, open sores began showing up on the lower half of both his legs.
David D’Angelo, DO
Holmes’s primary care physician referred him to Penn Wound Care and Hyperbaric Medicine at Chester County Hospital, a center that specializes in treating the full spectrum of wounds. Here, Holmes was diagnosed with chronic venous hypertension, a condition David D’Angelo, DO, the center’s medical director, describes as “very common and generally affect[ing] people beginning around middle age.”
Holmes sought treatment for it at the center, off and on, for the next 16 years. On average, patients at the center see their wounds heal over the course of 12 to 14 weeks. However, because of the nature of their wounds and the presence of other health conditions they may be living with, many (like Holmes) may need to return for further treatment.
Treating chronic wounds isn’t a sprint—it’s a marathon. “While chronic wounds can be successfully treated, they may reoccur over time for some patients,” said D’Angelo. “This is a common experience, and it speaks to the complexity of wound care. There are a myriad of variables that can contribute to a patient’s wound reopening, including any comorbid disease, advanced age, malnutrition, etc.”
For Holmes, the saga resulted in suffering. “I had no life then,” he said. “All I did was get treatment for the wound, but it was always very positive at the wound care center. They always treated me with care and gave me hope.”
State-of-the-Art Technology Meets Medical Expertise
When determining the best treatment plan, physicians overseeing wound care at Penn Medicine’s outpatient locations at both Chester County Hospital and Penn Presbyterian Medical Center may use an app called Tissue Analytics to measure the size of the wound in three dimensions using their smartphone. These measurements and images of the wound are uploaded to the patient’s PennChart, which helps inform treatment decisions.
The app also compares the patient’s wound, at different stages, to a national database, which enables the patient’s clinical team to see how a wound is healing, compared to both national healing rates and the patient’s previous appointments. This puts them in a position to adjust the treatment plan if the progress is accelerated or lagging versus the standard.
The two outpatient locations began using Tissue Analytics app in 2018 and it quickly became a crucial part of patients’ wound care journeys and treatment progression, including that of Holmes.
D’Angelo said he uses the app, in part, as a motivational tool. Because healing can occur very subtly, it's not always detectable by the naked eye. When D’Angelo encounters a patient who’s discouraged by their perceived lack of progress, he opens the app and shows them the promising reality.
Timothy Chen, DPM
“I like to say that Tissue Analytics enables me to tell a story visually,” he said. “They can see now how far they’ve come or why we need to consider other modalities.” And it gives patients a greater sense of agency during a process that doesn’t always go as planned.
In 2021, D’Angelo began collaborating on Holmes’s treatment with Timothy Chen, DPM, a podiatrist, before recommending that Chen take the lead. Chen essentially hit “restart” on the treatment process. He removed the unhealthy tissue from Holmes’s wound, then wrapped his lower right leg in multilayer bandaging for a period to control swelling caused by excess fluid trapped in the tissues.
The next step proved to be the turning point. Holmes wore a small vacuum pump over the wound for the next two weeks. This therapy, known as vacuum-assisted wound closure, uses pressure created by the pump to pull the edges of the wound together.
Finally, Chen covered the wound in a xenograft, a kind of skin graft that’s meant to temporarily shield the exposed tissue from contaminants and act like scaffolding for new skin cells to latch onto.
The Road to Recovery
Holmes last saw Chen in August 2022. In the months since, he has been meticulously wearing a compression sleeve on his lower right leg, as Chen instructed. The wound remains closed. In fact, this is the longest it has gone without reopening in the last 16 years.
“Each time, they went above and beyond for me,” Holmes said. “And they never hesitated to bring in someone else who might be able to help find a solution. Most people would write you off. They’d say, 'There’s nothing more we could do.' But they never stopped trying to help me.”
Holmes, now 66, said he’s gradually getting back to doing things he long ago stopped doing, including driving.
“Every day, I get up and I say, ‘I’m blessed,’” he said, “and I thank the people that helped me get my life back. I thank all of them.”