Comprehensive Treatment of a Traumatic Wound in Diabetic Patient

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					Comprehensive
Treatment
of
a
Traumatic
Wound
in
Diabetic
Patient
with
Chronic
Limb
Ischemia
(CLI)


Arti
B.
Masturzo,
M.D,
C.W.S.

St.
Elizabeth
Wound
and
Hyperbaric
Center




Purpose:

An
otherwise
uncomplicated
traumatic
wound
can
often
precipitate
major
amputation
in

patients
with
diabetes
and
concomitant
CLI.

BC
was
a
53
year
old
IDDM
female
patient
with
CLI,
failed

fem‐pop
bypass
with
unsuccessful
attempts
at
endovascular
intervention.

BC
presented
with
a
necrotic

ankle
ulcer
(photo
1)
related
to
trauma
and
resulting
ankle
fracture.

ABI
on
the
affected
limb
was
0.62

and
TCOM
showed
moderate‐to‐severe
tissue
hypoxia.

Due
to
anatomical
reasons,
re‐do
bypass
was

not
an
option
and
BC
refused
daily
HBOT.

A
comprehensive
approach
blending
endovascular

intervention
with
a
bi‐layered
tissue
engineered
skin
substitute
was
used.


Methods:

Initial
evaluation
included
non‐invasive
vascular
testing,
TCOM,
and
lab
work
showing
poly‐
nutritional
deficiencies
so
that
multivitamin
therapy
(vitamin
D,
L‐methyl
folate)
was
started.

HgbA1C

was
7.5
and
serum
protein
levels
were
within
normal
range.


BC
had
80%
SFA
stenosis
which
was

ballooned
and
occlusion
of
the
popliteal
artery
that
could
not
be
recanalized.

After
initial
treatment

with
serial
surgical
debridement,
BC
underwent
skin
substitute
applications
(photo
2).




Results:


Following
endovascular
intervention
and
surgical
debridements,
the
wound
appeared

significantly
less
necrotic
(photo
3)
and
was
readied
for
skin
substitute
application.

BC
had
healing
at

week
28
following
a
total
of
3
applications
(Wks
9,
14
and
19)
of
bio‐engineered
skin
substitute
(photo

4).


Conclusion:

Traumatic
wounds
are
often
precipitating
factors
for
major
amputations
in
patients
with

diabetes
and
CLI.

Comprehensive
therapy
utilizing
nutritional
support,
glycemic
optimization,

endovascular
techniques
and
advanced
skin
substitute
technology
may
enable
clinicians
to
successfully

heal
wounds
to
avoid
amputation.































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1:





























                                  











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2:
                                              


















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3:

                                   















Photo
4: