Diabetic Wound of the Lower Extremity

 

 
   Patient was treated at Our Lady
   of Fatima Hyperbaric Medicine
   Service which is affiliated with
   Praxis Clinical Services..

 
Diabetic Wound of the
Lower Extremity
Center for Wound Healing
and Hyperbaric Medicine
240 Williamson Street, Suite 104 - Elizabeth, NJ 07207
(908) 994-5480
HISTORY:
72 year old male with history of Type 2 Diabetes, Hypertension, ESRD on dialysis 3x/week, and significant PVD. The patient’s medical history prohibits him from being a candidate for revascularization. Patient presented to the Wound Healing Center with a non-healing wound status post right third toe amputation of 8 months and non-healing plantar wound of one month duration. The patient had been recommended to have a Transmetatarsal amputation from another wound
center.
INITIAL PRESENTATION:
- Wound measures 4cm x 2cm x 2.5cm, surrounded by an area of callus
- 2nd toe, necrotic tip of 2cm
- 4th toe, necrotic tip of 2.5cm
- Previous wound management: Dakin’s solution Bid
- TCPO2 demonstrates hypoxic wound margins with adequate response to 100% O2 challenge
COMPREHENSIVE WOUND HEALING CENTER MANAGEMENT:
03/23 Initiated HBO2 therapy at 2.0 ATA daily, referring physician refused to alter wound dressing routine from normal saline and Dakin’s solution.
04/06 Wound Measurements, 3cm x 2cm x 2cm, wound bed granulation 50%.
05/17 Topical therapy changed to Hydrogel dressing BID, sharp debridement of devitalized tissue.
06/04 HBO2 therapy completed after 49 treatments.
07/01 Plantar surface wound granulating with considerable epithelialization, measurements 5cm x 1.2cm x 1.3 cm. The necrotic toes are dry and stable.
08/30 Plantar wound measurements 1.3cm x 1.2cm x 1cm. Necrotic toes amputated.
11/04 Complete epithelialization of plantar wound.
RESULTS:
Healed foot that did not require a Transmetatarsal amputation.

Referral Information
Patients should be referred to the Center for Wound Healing and Hyperbaric Medicine at Trinitas Hospital for aggressive, outcome based wound management. Our center is designed to compliment the attending physician’s services by providing expert wound management consultation and care including the application of advanced wound care technology and hyperbaric oxygen treatment as indicated based on a comprehensive system of evidence based clinical practice guidelines. The referring physician will continue to treat comorbid conditions and provide for the patient’s overall medical care. Hyperbaric oxygen treatment is available specifically for the treatment of soft tissue radionecrosis, osteoradionecrosis, osteomyelitis, clostridial myonecrosis and other necrotizing soft tissue infections, compromised skin grafts and flaps, crush injuries and other acute traumatic ischemias, and diabetic wounds of the lower extremities. All etiologies of wound healing failure are accepted for evaluation and care.

Types of wounds treated include Diabetic, Venous Stasis, Ischemic, Pressure, Traumatic, Surgical and other wounds that resist healing.
Problem wound patients should be referred to the Center when:
The wound has failed to show significant progress in 4 weeks of standard care
When the wound involves deep tissue structures or is limb or life threatening
When the wound is complicated by significant comorbidities including peripheral
    vascular disease, persistent edema, persistent infection, prior radiation treatment
   to the area, or compromised immune status of the patient

To refer a patient, please call (908) 994-5480 or visit us at www.trinitashospital.com


 
 

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