Practice of Diabetology Carola Zemlin M.D., Wanzleben/Germany
Anamnesis
52 years old, male, type 1 diabetes mellitus with a duration of 27 years. Proliferative retinopathy, situation after cryocoagulation and vitrectomy bilateral; insulin 3x normal, NPH insulin in the morning and in the evening.
Multiple hospital stays because of recurrent lesions of the feet for at least 60 weeks between 1988 and 1998. Amputation of 4 toes of every foot, only the great toes are preserved. Extensive diabetic neuropathic osteo-arthropathy, that was misjudged for years and was not taken in consideration concerning orthopedic shoes, open lesions of the feet again and again. Most of the previous operations took place from platar and because of this stress for the sole of the foot by multiple scars.
Local pre-therapy
Foot bathes with chamomile and Rivanol, Betaisodona gauze resp. dry compresses.
Actual findings at 1998/09/30
First visit with two deep lesions at the right foot latero-plantar after sequestration. At this time a retinal haemorrhage with imminent loss of sight occur. The admission in a specialised hospital for sequestrectomy at the right foot we put back, because an immediate cryocoagulation of both eyes had priority. Excision of porotic bone material with Luer´s bone nipplers and bone curette. Systemic antibiosis with 3 x 300 mg clindamycin for several weeks. Daily tamponading with LIGASANO® white, soaked with Ringer´s solution, and on it gauze compresses and LIGASANO® white for padding, immobilisation to a large extend, only the going on his heels is allowed.
Fig. 1: 1998/09/30
Fig. 2: 1998/12/18
Small superficial bleeding after resection of a callus
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.