A 82-year-old woman with history of type 2 diabetes mellitus and percutaneous coronary intervention was referred to our university hospital with left infected foot ulcer. She kept walking because she didn’t feel any pain. She developed a small ulcer on lateral side of the left fourth toe when she stumbled one month ago. The wound became larger, her foot was swollen, and the IV toe became necrotic.
Venous leg ulcer, pressure ulcer, vasculitis, skin cancer, pyoderma gangrenosum
Wound specialist, Wound nurse, Endovascular Surgeon, Vascular surgeon, Radiologist, Diabetologist, Ultrasound technician
After emergency hospitalization, culture from the deep area of the ulcer was taken and antibiotics treatment was started. Antibiotics was performed empirically fist and changed to the most sensitive one based on the culture results. ABI was 0.8 of right and 0.44 of left. Contrast CT and angiography revealed the arterial occlusion of common femoral artery (CFA).
After revascularization by endarterectomy of CFA, emergency debridement was performed and left the wound open. 7 days later, additional debridement was performed and applied Negative pressure wound therapy with instillation and dwell time;NPWTi-d ( 3M™ V.A.C. ®️ Ulta Therapy System; 3M). After 3 weeks, infection was completely controlled and wound bed preparation was completed. Mesh skin graft was performed and wound was healed without any complication.
After 2 years the wound had stayed healed and she could walk with custom made foot ware. There was no recurrence.