Practice of Diabetology Carola Zemlin M.D., Wanzleben/Germany
Anamnesis
41 years old, female, type 1 diabetes mellitus, duration 15 years. Insulin therapy: insulin pump with H-Tronin. Wound healing disturbation at the right foot after amputation of toes (3-5) and metatarsectomy (4-5), diabetic neuropathic osteo-arthropathy (Charcot foot). Cause for the amputation of the toes were infected clavi. Initial local therapy in the hospital: treatment with jodine and foot baths. Because of a progressive infection with osteomyelitis amputations of the toes and afterwards metatarsectomy took place, 61 days of hospital stay. Due to the poor healing tendency amputation is suggested.
Actual findings at 1999/07/16
Findings at the virst visit in our ambulanve: gaping wound at the right lateral forefoot, dimensions of 10 x 1.5 cm with a depth of 1 cm. Smeary brownish tinged wound coating, anhidrosis, feet over-warmed, swollen and contracted; sensibility for temperature, vibrations and touches is lapsed, pulses of the feet vigorous palpapel, tip foot in supinate position.
Fig. 1: 1999/07/16
Fig. 2:1999/08/13
Beginning of the local treatment with an extensive debridement by scalpel and bone curette. Afterward refreshening of the wound edges, application of sterile LIGASANO® white (soaked with blood of one´s own). We equip the patient with a cast adapted to neuropathy because of acute risk of fractures. After 6 weeks closure of the wound.
Study about the use of LIGASANO® white as initial wound dressing at foot disease caused by diabetics, of Carola Zemlin, M.D., internist/diabetologist. For the evaluation of the study please click here.