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Case Study
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Detection and management to healing of 25-year-old venous leg ulceration in a 78-year-old female Alan Cantor, DPM, Keith Burger, PA-C, Donna Hangan, NP, Paul Scott, MD A 78-year-old woman was referred to our center for chronic right leg venous ulcerations and edema present for 25 years with no sustained period of defect closure Upon initial evaluation, the site was biopsied and revealed squamous cell carcinoma The patient was taken to the OR for radical debidement and excision of the tumour. Wide margin excision was performed and upon pathological evaluation, healthy specimen margins were noted VAC therapy was applied directly in OR and patient was seen in wound center for dressing changes and wound bed optimization. After 3 weeks of VAC therapy, the patient was scheduled for a split thickness skin graft. The graft was immediately covered with VAC therapy and observed closely post operatively. First graft inspection revealed excellent graft incorporation with no visible graft loss or rejection. Acticoat dressing was applied under the VAC and this protocol remained in effect for 3 weeks 3 weeks after graft application, the ulceration was fully covered with healthy epithelialized skin. MUlti layer compression was continued to control edema and patient healed without complications Authors highlight the need to biopsy all non healing wounds of prolonged duration. This case illustrates the cost, pain, and emotional and physical toll this patient endured simply due to no prior wound biopsy being obtained. |
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