Male patient with a previous history of being a heavy smoker. He was treated by the Podiatry Service for an ulcer on the left foot. No further vascular intervention was possible on this side. He had previously undergone a below knee amputation on the right side. The patient had just completed 6 weeks of IV antibiotics and the wound was still deep to bone. An x-ray of the foot indicated that osteomyelitis was present. The first metatarsal head was loose and protruding through the skin and was removed in clinic. He was allergic and intolerant to all oral antibiotic options.
Treatment
Following debridement and cleansing of the wound, STIMULAN beads were mixed with antibiotic and packed into the cavity. They were held in place with Mepitel wound contact layer (Molnlycke) with a secondary dressing of Kerramax Care (3M+KCI) used to absorb exudate. The patient was seen weekly and a sharp debridement was carried out to remove surrounding callous. STIMULAN beads remained in situ and were renewed at 4 weeks. As the ulcer had reduced in size, a smaller sized bead was used.
Outcome
The patient tolerated this treatment with no adverse events, and he experienced no additional discomfort. X-rays were taken during treatment and showed no further progression of the osteomyelitis. After 5 months the wound was progressing well and had almost healed. Treatment with antibiotics was discontinued. As a result, the patient did not require amputation of his foot. Note: See STIMULAN page for regulatory statements. MA0404R1
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