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Oral Abstracts (Session 1 of 5)
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(Presentation 32.5) Healing of a 2-year-old traumatic ankle ulcer in an elderly woman with diabetes using an acellular regenerative tissue matrix Brock A. Liden, DPM; Jodi F. Hartman, MS; Michelle L. Wright, BS A 68-year-old woman with diabetes and a history of smoking and partial occlusion of the anterior tibial artery was referred to the wound care clinic by an orthopedic surgeon for evaluation of an anterior tibial distal ulcer measuring 1.5 cm x 1.0 cm x 0.2 cm with a small amount of drainage and a visible anterior tibial tendon. The patient had fallen more than 2 years ago, sustaining a displaced ankle fracture. After open reduction with internal fixation, the patient began experiencing persistent pain. Irrigation and debridement was performed after a Ceratec white blood cell scan suggested osteomyelitis. Cultures confirmed osteomyelitis, and the patient was placed on oral antibiotics. The original wound never healed despite multiple treatment attempts over the previous 2 years, and the patient has been resigned to a walker. Two other surgeons recommended below-knee amputation. The current treatment goal, however, was to resolve any residual infection and achieve wound closure to allow a future ankle fusion. Surgery was performed involving hardware removal, curettage of the tibia, implantation of vancomycin-impregnated calcium sulfate beads, and application of an acellular regenerative tissue matrix for wound closure. Postoperative wound management involved a multi-modal approach. Graft incorporation was achieved by postoperative Day 4, and 100% granulation occurred at 12.4 weeks. The wound was completely healed at 15.4 weeks with no signs of infection. Ambulation was permitted with the use of a CAM boot, and the patient was referred back to the orthopedic surgeon. An ankle fusion recently was performed, the outcome of which is pending. This case report illustrates successful treatment of a 2-year-old traumatic ulcer in a patient who otherwise would have been treated with a below-knee amputation. As a result of this treatment protocol, the patient now has the potential for a full recovery, including full weight-bearing ambulation. |
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