Glyceryl trinitrate patch therapy is associated with healing of arterial ulceration and improvement in toe pressure measurements: a case study and discussion of aspects of this novel treatment modality

A case study of one frail elderly client with indolent arterial
ulceration was conducted, with glyceryl trinitrate
(GTN) patch therapy appearing to have a positive role in
the healing outcome and improved vascular status as measured
by photoplethysmography (PPG ) toe pressure measurements.
The history and pharmacological action of this
novel mode of therapy are briefly presented. The presentation
of chilblains (erythema pernio) and arterial ulceration
are discussed in the context of this case. Loss of sensitivity
to cold perception, related to age, arterial insufficiency and
other factors are considered. Current research using this
medication for other applications suggests that GTN
patch therapy should have a positive role in healing arterial
ulceration associated with peripheral vascular disease
(PVD). Positive outcomes with painful diabetic neuropathy
have also been found with this therapy and its use warrants
further investigation. A review of the literature on
the use of GTN therapy for digits is briefly summarised.
Important to clinical treatment of aged people with
reduced vascular supply are decreased sensory functions
of pain, protective sensation and temperature sensation.
Further research on the effects of GTN therapy for wound
healing should aim to control for seasonal climate and
environmental temperature changes, as well as other factors
that influence wound healing such as wound care,
wound dressings and nutrition.