BH WOUND CARE | Case Study 107

Ricardo M., a 48-year-old Hispanic male with type II diabetes mellitus, presented with a severe and complex foot ulcer. The ulcer was located on the dorso-lateral aspect of his left foot and extended to involve the fifth digit, with associated gas gangrene that had spread to the left ankle. Due to Ricardo’s occupation as a laborer and his limited recollection of the wound’s onset, the exact cause and duration of the ulcer were unclear. Ricardo underwent surgical incision and drainage with debridement in the operating room (OR) and was subsequently placed on a KCI negative pressure wound vacuum for several weeks. The wound’s initial size was approximately 150 square cm.

• Age: 48
• Medical History: Type II diabetes mellitus
• Wound Presentation: Complex foot ulcer with gangrene affecting the fifth digit and spreading to the left ankle
• Occupation: Laborer
• Limited wound history and unclear onset

The primary objective of this case study was to document the successful treatment of Ricardo’s complex foot ulcer, achieve wound healing, manage diabetes, and prevent future complications, including recurrent ulcers.

1. Wound Identification: Comprehensive wound assessment, monofilament testing for neuropathy, Ankle-Brachial Index (ABI) and Toe-Brachial Index (TBI) measurements, transcutaneous oxygen pressure (TCPO2) and skin perfusion pressure assessments, and noninvasive vascular evaluation.
2. Ulcer Assessment: Determination of ulcer type, including neuropathic ulcer, neuroischemic ulcer, and ischemic ulcer.
3. Glucose Control: Diabetes management and lipid control to optimize overall health and support wound healing.
4. Nutrition: Dietary modifications, smoking cessation, and lifestyle changes to promote healing.
5. Ultra-Mist Therapy: Administered 1-2 times per week to aid in wound healing and tissue regeneration.
6. Amniotic Tissue Application: Utilization of amniotic tissue for its regenerative properties by covering with adaptic non-adherent contact layer and securing with moisture retentive dressing.
7. Prevention Plan: Implementation of a lifelong program involving proper footwear, patient education, and close follow-up to prevent future ulceration.
8. Wound Healing: The ulcer achieved complete healing in 3 months.

• First Dressing Change: Early signs of healing were evident at the first dressing change.
• 3 Weeks: Substantial improvement in wound appearance and size was observed at 5 weeks.
• Fully Healed at 3 Months: The wound achieved complete healing and closure, marking a successful outcome.

This case study demonstrates the successful treatment of a complex foot ulcer with gangrene in a patient with type II diabetes mellitus. Through a comprehensive treatment protocol encompassing wound assessment, diabetes management, nutritional support, advanced wound therapies, and preventive measures, the ulcer achieved complete healing in just 3 months. Early signs of improvement were evident, underscoring the effectiveness of the chosen interventions and emphasizing the importance of a multidisciplinary approach to managing complex diabetic foot ulcers.