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Case Studies

Case 1:

TOE INFECTION IN A K/C/O DIABETES WITH CALCIFIED VESSELS AND ABI<0.9.Patient had no pain at presentation.Otherthan a Blood Sugar > 250mg%(his normal was less than 140mg% PP), no other abnormal finding was there.


Before	Immediate post debridement

After 2 Weeks	After 6 Weeks

Case 2:

K/C/O OF DIABETES MELLITUS WITH NECROTIZING FASCIITIS. PATIENT CAME WITH HIGH BLOOD SUGARS, INGUINAL LYMPHADENITIS, LOWGRADE FEVER, BUT NO PAIN


Before	After 10 days	After 8 weeks

Case 3:

FOOT INFECTION(WET GANGRENE) IN A DIABETIC WITH LONG HISTORY OF SMOKING. ON ANGIOGRAPHY, THE SUPERFICIAL FEMORAL ARTERIES WERE 100% BLOCKED AND PERIPHERAL ARTERIAL RUNOFF WAS POOR. PATIENT HEALED WITHOUT A BYPASS GRAFT AND I MUST STRESS ALSO WITHOUT A SKIN GRAFT

Case 4:

WET GANGRENE IN PATIENT WITH DIABETES MELLITUS, HYPERTENSION, .90% BLOCKED SUPERFICIAL FEMORAL ARTERY WITH POOR RUNOFF.PATIENT WAS UNFIT FOR VASCULAR BYPASS
3 DAYS POST DEBRIDEMENT, A TRANSMETATARSAL AMPUTATION WAS CARRIED OUT WITHOUT DOING A VASCULAR BYPASS


12 WEEKS AFTER THE INITIAL EVENT, PATIENT WAS MOBILIZED IN CUSTOMIZED FOOTWEAR. NO SKIN GRAFTING WAS CARRIED OUT DURING THE ENTIRE PROCESS OF HEALING

VENOUS PROBLEMS

Case 5:

VENOUS ULCER->5 YEARS DURATION. Patient was a teacher who had undergone multiple skin grafting surgeries, before coming tous.


Before	Fully Healed after 12 Weeks

Case 6:

LONG STANDING ECZEMA.PATIENT CAME WITH CELLULITIS, LEG SWELLING AND A NON HEALING ULCER FOR >3 MONTHS. HE HAD CVI WITH SAPHENOFEMORAL INCOMPETENCE AND MULTIPLE PERFORATOR INCOMPETENCE WITH NO OBVIOUS SUPERFICIAL VARICOSE VEINS.


Before	after 6 Weeks

ULCERS WITH MULTIFACTORIAL ETIOLOGY

Case 7:

VENOUS ULCER WITH PAD WITH DIABETES & RHEUMATOID ARTHRITIS.

Before

Fully healed after 3 Weeks

Case 8:

NON HEALING ULCER IN PATIENT WITH CHRONIC VENOUS INSUFFICIENCY, PERIPHERAL ARTERIAL DISEASE & CHRONIC OSTEOMYELITIS OF THE ANKLE JOINT.

Before

Completely healed at 2 weeks Post surgery

Case 9:

NON HEALING ULCER FOR > 25 YEARS.PATIENT HAD CHARCOTS FOOT, WITH DEEP VENOUS INSUFFICIENCY AND PERIPHERAL ARTERIAL DISEASE.


Before	Fully healed within 3 Weeks of Customised Foot Wear & other supportive treatment

Case 10:

Tendo achilles wound in a patient with peripheral arterial disease, diabetes mellitus, ischaemic heart disease, post renal transplant on steroids.

At Presentation 6 months after starting wound care

Case 11

Stage IV bedsore in a known case of diabetes mellitus, ischemic heart disease, peripheral arterial disease

At Presentation Few Months after Surgery, Wound Care (NPWT & Silver)

One point which I would like to stress upon, as a rule we avoid doing skin grafts where possible i.e. 95% of our patients. We prefer natural healing over skin grafts especially in areas where pressure is bound to be there like plantar ulcers, patients with deep venous insufficiency etc. As in these locations graft breakdown and loss is very common. The cases where we may advocate skin grafting are large traumatic ulcers and accident cases where it is important to achieve skin cover as rapidly as possible

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