Practice of Diabetology Carola Zemlin M.D., Wanzleben/Germany
59 years old, male, type 2 diabetes mellitus, known since 11 years, therapy with insulin since one year, coronary heart disease; state after myocardial infarct in June 1998; adrenal insifficiency in need for substitution, heavy nicotinism.
Amputation of the left lower leg (injury in the youth); amputation of the right hallux in 1988; amputation of the 2nd right toe in November 1998, since then wound healing disorder. The amputation of the contralateral leg is adviced, because revascularization is impossible. First visit in our ambulance at 1999/02/24.
ointment containing povidone-jodine, foot bathes
Actual findings at 1999/02/24
Non-painful lesion in the amputation area of the 2nd right toe. The exploring forceps hits after 1.5 cm on bones (WAGNER 2, type C according to ARLT). Furthermore plane ulcers at the medial foot border and the heel, necrotic coatings. Foot pulses: A. popl. good echogenic, A. dors. ped. poor, Doppler pressure 100 mmHg at systemic pressure of 140 Torr systolic, thereby warm and dry feet. Additionally symptomes of polyneuropathy (sensitivity for temperature and pain lapsed, no ischaemia pain despite significant arterial occlusive disease). Shoe supply calamitous (too narrow, too short, hard toe caps).
Fig. 1: 1999/02/24 Lesion in the amputation area
Fig. 2: 1999/02/24 Ulcers on heel and medial foot border
Fig. 3: 1999/04/24
Refresh of the wounds and excision of the necrosis with the scalpel, in the resection area daily change of the sterile LIGASANO® white stripes, soaked with Ringers´s solution. At the medial foot border application of LIGASANO® white and a dressing with activated carbon and silver in turn, because we have made good experiences with it in patients with arterial occlusive disease. Additionally we applicate a bandage of LIGASANO® white (5 cm in width) for padding over the primary dressing. Furthermore the patient received a temporary shoe supply and after the complete healing adapted orthopedic shoes.
Fig. 4: 1999/05/18
Fig. 5: 1999/08/04
Fig. 6: 1999/09/24
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.