Nonhealing Ulcer in a Diabetic Foot

James W. Christopher, MD; Benjamin D. Li, MD; Enrique Gonzalez, MD; John P. Valiulis, MD; Marshall Cunningham, MD; Joseph McCulloch, PhD

Disclosures

Wounds. 2004;16(6) 

In This Article

Presentation

A 66-year-old Black man with type 2 diabetes, hypertension, chronic renal insufficiency, and peripheral vascular disease was referred from the community to the Physical Therapy Wound Care Clinic at Louisiana State University Health Sciences Center. The patient had sustained a scald burn to the entire right foot in 1985. His initial treatment of his burn wound included excision and split-thickness grafting of the dorsum of the foot, while the plantar surface was allowed to heal by secondary intention. According to the patient, the wound on the dorsum healed well, but the plantar wound did not. Two years post burn, the patient underwent a left below-knee amputation due to peripheral vascular disease. This made healing of his plantar wound more unlikely due to his dependence upon his right foot. Over the course of fifteen years, various therapies and topical applications were utilized to promote healing without success.

At the time of his referral to Physical Therapy, he had an ulcer on the plantar surface of his right foot measuring 28cm2 (Figure 1). The ulcer was covered with adherent fibrinous exudate and bled easily. The margins of the wound were hypertrophic. Dorsalis pedis and posterior tibial pulses were not palpable. There was a 2+ pitting edema to mid-calf. The ulcer was classifed as I-C based on the University of Texas wound classification system.[1]

Shown here is the chronic ulcer on the right heel of a 66-year-old Black man with type 2 diabetes, hypertension, chronic renal insufficiency, and peripheral vascular disease.

Initial therapy consisted of cleansing with pulsatile lavage with suction followed by the application of a semipermeable foam dressing. The patient was fitted with a heel wedge to offweight the ulcer. Concerned at the patient's lack of response to conventional therapies and the extreme duration of the ulcer, the physical therapist requested an evaluation by the plastic surgeons in the Diabetic Limb and Wound Care Clinic.

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