Transform diabetic foot ulcer

Courtesy of Mr Martin Arissol Msc. BSc Hons, Vascular Podiatrist lead. Non-medical independent prescriber, London, UK
Products: STIMULAN®
Clinical history
45-year-old female with a history of Type II diabetes, Peripheral Neuropathy and previous 2nd and 3rd toe amputations. The patient presented to clinic with inflammation and ulceration sinus to the apex of the right hallux. An x-ray showed bone destruction and osteomyelitis that was not salvageable. The patient consented to a right hallux amputation and commenced on 2 weeks of IV antibiotics followed by oral antibiotics on discharge. The patient was reviewed in the foot clinic weekly. 5 weeks post-discharge, the patient was readmitted with an acute tracking cellulitis to the amputation site. The amputation site was still probing to bone, painful and infection was present. An MRI presented osteomyelitis to the 1st metatarsal and the patient had surgical revision of the infected bone. Microbiology results showed Corynebacterium striatum grown from bone and tissue. This was resistant to penicillin, gentamicin, erythromycin and tetracycline. The MDT agreed a plan to discharge the patient with at home parenteral antibiotics via a PICC line. A complication developed with the PICC line and formation of a thrombus to brachial to subclavian vein. The PICC line was removed.  
5cc STIMULAN mixed with antibiotic was packed into the wound. The beads were sealed in with Adaptic Touch™, non-adhering silicone contact layer, and mefix tape. A secondary layer of sterile gauze, Soffban® and crepe bandages applied to manage the exudate levels. The gentamicin level at week 1 was <0.55mg/L, and the gentamicin level at week 4 was <0.40mg/L. At 5 weeks post implantation, STIMULAN beads were removed due to suspicion of infection but then repacked into the wound with no acute concerns.  
The wound healed well and by 25 weeks had healed fully. This was a great result in a complex case of a thrombus due to a PICC line insertion, which made the use of out-patient parenteral antibiotics not an option anymore. The patient experienced rapid healing using STIMULAN as an alternative local antimicrobial therapy.

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