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Case Study
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Limb preservation in a neuropathic diabetic with third degree scald burns to right foot Alan Cantor, DPM, Donna Hangan, RN, Paul Scott, MD A 66-year-old IDDM, PVD, Neuropathic patient was referred to our burn/wound and hyperbaric service after sustaining 3rd degree scald burns to his right forefoot after soaking in hot water for an ingrown toenail. Prior to referral, the patient was misdiagnosed with "athletes foot" and the burn injury progressed into necrosis of the 2-4 toes on right foot Patient was brough to Or for debridemnt of necrotic tissue. IVABX, topical silver therapy and hyperbaric oxygen was initiated. Soon the toes became gangrenous and proximal abscess and infection was noted Patient was returned to Or for amputation of infected digits with osteomyelitis. Post op HBOT was continued and VAC therapy applied. Additional infection warranted transmetatarsal amputation, and the defcet wasleft open due to infection. VAC and HBO was continued. Afetr no healthy tissue was formed, necrotic soft tissue was debided with the VersaJet hydrinsicion system a proximal Chopart's rearfoot amputation was performed. Healthy tissue was observed. After 10 days of ongoing HBOT and ABX, the wound bed was optimized for soft tissue closure. Patient was returned to OR for application of a split thickness skin graft. VAC was re-applied in the OR immediately after grafting and was brought directly to the HBO center for graft preservation The patient went on to full recovery and maintained majority of the lower extremity, which was encouraged to be amputated by other clinicians Interdisciplinary care, fluid treatment plans and serial debridement salvaged this patients leg and hindfoot. He was fitted with a custom show with forefoot prosthetic and remains ambulatory and complication free. Authors advocate clinicians not trained in burn injries or critical limb threatening wounds refer patients to a specialized center for a comprehensive limb preservation treatment protocol. |
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