9 Clinical Cases of Nonhealing Pressure Ulcers in Patients With Spinal Cord Injury Treated with an Anabolic Agent: A Therapeutic Trial

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Abstract
Anabolic steroid agents may potentially promote wound healing in individuals with spinal cord injury who have long-standing wounds. Nine patients hospitalized on the Spinal Cord Injury Service of the VA Medical Center, Bronx, NY, received treatment with an anabolic agent and amino acid supplement. Selection of patients was based on having at least 1 of the following criteria: (1) nonhealing pressure ulcer of at least 2 months' duration with no change or worsening status, and/or (2) full-thickness pressure ulcer through fascia into muscle, tendon, or bone. Previous and current pressure ulcer histories were determined by review of the hospital records when available and/or self-reporting by the patient. Eight of 9 patients had nonhealing wounds of 2 months' to 5 years' duration. One patient was included because of having a large, full-thickness pressure ulcer of reportedly 2 weeks' duration. Except for 1 Stage III pressure ulcer, all others had Stage IV pressure ulcers. Three patients had documented weight loss (> 10% of total body weight), 3 had no recent weight loss, and 3 refused to be weighed. Patients were treated from 1 to 12 months with oxandrolone (20 mg/day) and glutamine (20 g/day). Eight of 9 patients completely healed: 3 after 3 months, 2 after 4 months, 1 after 6 months, and 2 after 12 months of treatment. One patient was discharged against medical advice after 1 month of treatment with a healing wound and was lost to follow-up. Although clinical case studies have limited usefulness for determining effectiveness of drug therapy on wound healing, these initial observations of successful treatment with an anabolic agent and amino acid supplement have been encouraging.