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Case Study – Ulcer, Greater Toe


Admit Date

06.06.2018

Time to Heal

54 Days

Diagnosis

Diabetic ulcer on left great toe

Relevant History

66 year old male with history of hypertension and type II diabetes admitted to the hospital 2 weeks prior for sepsis of the wound. Patient was administered Ampicillin every 4 hours IV per picc line while in hospital. Wound is approximately 2 months old when appeared in clinic.

7 STEPS TO WOUND HEALING

graphic showing the 7 steps to wound healing
  1. Blood Flow
    ABI test was performed with results within normal limits at 1.4.
  2. Infection
    Infection was confirmed with patient was in hospital. They received Ampicillin every 4 hours via picc line while in hospital.
  3. Debridement
    Subcutaneous tissue level surgical debridement performed for 5 sessions to remove non-viable tissue in order to stimulate wound healing. The wound was initially measured at 4.3 x 2.2 x 0.4 cm prior to initial surgical debridement and was healed in 7 weeks.
  4. Glucose Control
    Patient takes Lantus Solostar Insulin 3 mL once daily and Novolog PenFill Insulin aspart 100 unit/mL subcutaneous with meals. Patient continued to check blood sugar on a daily basis and kept blood sugar under control.
  5. Offloading
    Patient was instructed not to stand on left leg for long periods of time.
  6. Optimize Host Factors (Nutrition)
    Patient was encouraged to keep a diabetic log to track food intake.
  7. Moisture Control/Appropriate Dressings
    Calmoseptine applied to peri wound to protect surrounding skin. Primary dressing applied with promogran to wound bed followed by Silver alginate.
6/6/2018
4.3 x 2.2 x 0.4
6/27/2018
2 x 2.1 x 0.2
7/11/2018
1.3 x 1.4 x 0.2
7/25/2018
HEALED