Abstract
BACKGROUND: The management of stage IV pressure ulcers (PUs) in elderly, high-risk surgical patients remains a formidable clinical challenge, often limited by the invasiveness and risks of standard surgical options. Although Aloe vera has known wound-healing properties, clinical evidence of its efficacy in complex, severe PUs is scarce. This case report details a novel, non-invasive combination therapy centered around an aloe-derived micellar emulsion dressing (Aloe vera barbadensis extract R, AVBER) and demonstrates its potential as a viable palliative strategy for this vulnerable population. CASE SUMMARY: A 90-year-old, severely malnourished female (body mass index 13.3 kg/m(2)) presented with extensive, bilateral stage IV ischial PUs following a femoral fracture. Given her frailty and high surgical risk, a conservative regimen was initiated. This regimen comprised the topical application of an AVBER dressing, targeted red light therapy, and intensive nutritional support, all guided through telemedicine. Over a period of 8.5 months, this treatment was associated with complete healing of the left ulcer and near-complete resolution (from 15 cm × 15 cm to 0.8 cm × 3.0 cm) of the right ulcer, with no serious adverse events reported. The PU scale for healing score for the right ischial ulcer decreased markedly from 17 to 6. CONCLUSION: AVBER-based combination therapy represents a promising non-invasive option for managing severe PUs in surgically ineligible patients.