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Diabetic Foot Ulcer
Diabetes often results in chronic foot wounds because of poor circulation, impaired immune system, and nerve damage that may numb the feet and delay detection of wounds.
Thorough cleaning (debridement) and the protection of the wound with appropriate bandages and padding are needed for optimal wound healing.
Prolonged bed rest during long hospital stays or chronic illness can lead to "bed sores", known as pressure ulcers. They are often seen in the back of heels, but are also common around buttock and hips. Thorough cleaning of the wound, providing appropriate protection for the heels, and proper cushioning for patients in wheel chairs and those who spend the majority of time in bed are important steps to treating and preventing pressure ulcers.
Venous Leg Ulcer
Venous insufficiency, or backward blood flow in the veins, is a very common problem, often seen in female and elderly patients. Venous insufficiency causes swelling of the legs, and thinning and ulceration of the skin.
This type of wound usually becomes chronic, lasting longer than 4 weeks, unless the wound is cleaned thoroughly and leg swelling is controlled adequately with compression bandages.
Diabetic Neuropathic Foot Ulcer
Diabetes can elevates your blood sugar to abnormal levels (hyperglycemia), which damage your nerves in your legs slowly over many years. The end result is insensate or numb feet. In this case, a diabetic patient created a foot ulcer by walking too much with a severe bunion bone deformity (Hallux Valgus). Most of these foot ulcers can be treated with prescription shoes and proper wound care treatment. In severe or chronic cases, the bones can be removed or shaved to heal the ulcer and prevent future recurrence.
Various trauma, from running into a coffee table to getting hit by a car, can lead to skin break-down, or "traumatic wounds." In this case, this person's foot was run over by a slow-moving car, resulting in a large gaping wound and ankle fracture.
This particular wound was treated successfully by using negative pressure wound therapy (Wound VAC) and artificial skin graft (Oasis) to repair the skin defect. After 3 months of treatment, the patient healed well with minimal scarring and was able to walk normally without pain afterwards.
A "burn" is a type of injury inflicted by heat (or thermal energy). The severity and depth of injury depends on the amount of thermal energy applied to the body. The amount of thermal energy is roughly proportional to the temperature of the heat source multiplied by the amount of time the skin was exposed.
Burn wounds are categorized into a 1st - 4th degree burn. When you get a sunburn, it is usually a 1st degree burn (redness of skin). Spilled hot coffee on the skin may result in the 2nd degree burn (redness with blister formation). Exposure to more thermal energy, such as spilled hot oil or a house fire, may result in 3rd degree (loss of full-thickness skin) or 4th degree burns (loss of tissue down to muscle and bone).
In this case, a patient with numb feet (commonly seen in diabetic patients) used a heating pad for an hour, and ended up with a 3rd degree burn wound. The damaged skin died and left a pseudo-eschar (yellow dead layer of skin), which had to be removed surgically. The patient was followed with weekly wound care visits and received applications of skin substitutes (artificial skin graft), and the wound healed uneventfully with a small scar.
Although surgeons take meticulous care in sterilizing and preparing the patient's skin prior to surgery, infections are a rare complication of surgery. For example, "clean" orthopedic surgery carries an infection rate of about 1%. On average, 1 out of 100 cases may result in infection of the surgical wound and opening of the suture line. We work closely with your surgeons and strive for the fastest closure of these surgical wounds. In this case, the patient suffered an Achilles tendon rupture, which was repaired by an orthopedic surgeon. A few days after surgery, the wound became infected and the incision opened (known as wound dehiscence). We removed the infected tissues surgically, then applied the Wound VAC device over the incision as an active draining device. The patient healed uneventfully in 4 weeks.
Complex Surgical Wound
Complex foot wound with bone exposure often calls for the use of muscle flap or free flap with skin graft; however, in some cases, the patient's health may be compromised, and such a procedure may not be prudent.
This case involves a patient with double transplant (heart and kidney) with subsequent critical limb ischemia with gangrenous forefoot. This wound was successfully managed with surgical excision of necrotic tissues, serial 35kHz ultrasound debridement, placement of Wound VAC device over the bones to form healthy granulation tissue, and subsequent skin substitute applications (Dermagraft). Although the patient was slow to improve due to her immuno-suppressive medications, we were able to achieve complete wound closure and resume ambulation in 5 months.
Lymphedema Leg Wounds
Lymphedema is a condition where the flow of lymph fluid gets blocked and creates massive swelling of upper and lower extremities. Lymphedema can be congenital (meaning you are born with lymphedema), but more commonly it can happen with surgery (especially in lymph node biopsies associated with cancer surgery) or with unknown causes (idiopathic lymphedema). The treatment of lymphedema leg wounds are similar to those of venous leg ulcers, meaning appropriate debridement, dressings, and compression bandaging is the key to swift healing.
In this case, a middle-age patient developed bilateral leg lymphedema of an unknown cause. Severely painful leg ulcers that spanned the entire ankle developed and became chronic over 6 months. She was treated with weekly wound debridement using our ultrasound debridement device, as well as wound dressings with absorbent foam and multi-layer compression wraps. The leg ulcers healed uneventfully in 6 weeks.
Inflammatory Leg Ulcers (pyoderma gangrenosum)
Inflammatory leg ulcer is a relatively rare disease associated with various auto-immune conditions, such as rheumatoid arthritis, inflammatory bowel disease etc. Pyoderma gangrenosum is another term for inflammatory leg ulcerations. These painful ulcers are caused by the inflamed blood vessels that break down the overlying skin. Once the acute inflammation is treated with appropriate medications, these leg ulcers can be treated with conventional local wound care treatments, such as ultrasound debridement, moist wound dressings, and compression therapy as needed.
In this case, a patient with long-term rheumatoid arthritis developed painful inflammatory leg ulcers. After his rheumatologist treated him with anti-inflammatory medications, the leg ulcers were treated with ultrasound debridement, anti-microbial silver foam dressing (Mepilex Ag) and mild compression therapy. His leg healed uneventfully in 8 weeks.
Before and After