This 80-year-old male weighing 475 pounds (BMI= 64) fell at home while getting out of his bathroom shower. Due to his large size, Emergency Medical Services had to cut him out of his bathtub where he had been trapped for several hours. He was hospitalized and cared for by the Orthopedic Service for 1 month prior to consulting the Plastic Surgery service for treating his open right ankle wound
.Initial wound management with NPWT- note the hydrocolloid dressing was being used to protect the fragile venous stasis ulcer prone skinDuring this admission he had been treated twice for his acutely fractured ankle. Initially it was managed with both internal and external ankle fixation but 1 week later it was converted to total internal fixation after he refractured it while getting up and trying to ambulate on his own. His ankle wound had been managed with negative pressure wound therapy by the Orthopedic Surgical service prior to consultation
In addition to being an octogenarian, he had asthma, COPD, depression, anxiety, type 2 diabetes, hypertension, hyperparathyroidism, osteoporosis, psoriasis, marked venous stasis disease, an old Charcot foot injury of his left foot and he stopped smoking at age 73. He has a family history of having a Protein S deficiency.
.The large full thickness medial right ankle wound was 12 cm. in length with exposed metal hardware, bone, tendons and had a degloving component extending around and down into the ankle joint. There was a 17 cm long oblique wound above the open ankle wound
Recent wound cultures were positive for Enterobacter cloacae, Bacteriodes fragilis & Diptheroids