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Case Study
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Management of open leg fracture with bone infection in a diabetic with 2-year-old nonhealing wound using multimodal therapy Alan Cantor, DPM, Donna Hangan, NP, Charles Ruotolo, MD, Thomas Davenport, MD, Nassau University Medical Center, East Meadow, NY A 55-year-old diabetic was referred cited to our service 2.5 years after sustaining compound fracture of her left leg to to a fall from a ladder. Patient underwent numerous ORIF procedures and developed osteomyelitis. She was treated with HBOT at another facility before referral to lead author for limb salvage evaluation Initial exam revealed a 3.0 x 3.0 cm ulcer probing to tibia with exposed internal fixation. The patient was immediately referred to our orthopedic service for assessemnt of the non healing fracture and coordination of care ABX were initiated based upon culture derived specimen. Serial deep debridement od necrotic bone and soft tissue were performed. The fracture site was realigned and infected internal fixation were removed and external fixation was applied HBOT was started to help with anti-infective therapy, stimulate bone regeneration and optimize the wound for planned soft tissue closure Topical care consisted of silver impregnated dressings and multi layered compression dressings. As the wound began to contract, Regranex therapy and Prisma were then applied to the defect, which promoted marked healthy granulation tissue and epithelialized tissue. Edema was markedly reduced with HBOT and compression. As wound defect progressed, application of Oasis was applied and covered with Regranex and VAC After 16 months of comprehensive team oriented care with the wound service, hyperbaric center, orthopedics and plastic surgery service, this patient fully healed without need for surgical grafting or muscle flap as was thought necessary The authors highlight the need for timely referral and coordinated team care. In this case, 24 months after initial injury, and 12 months after inheriting this complex case, the patient was discharged with a fully healed leg which had been considered for below knee amputation. |
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