Transform diabetic foot ulcer

Clinical history

83-year-old female with a history of Type II diabetes, vascular dementia, hypertension, asthma, osteoarthritis, congenital heart defect, and bilateral leg oedema with HO varicose ulcerations.

The patient presented to A&E with worsening infection. She reported leg ulcers for 3 years with new ulceration to left heel which was very painful and bleeding.

Treatment

The left heel was debrided and loaded with STIMULAN mixed with antibiotic. At 1 week, the dressing was changed, STIMULAN beads remained in-situ and the patient’s oral antibiotics were changed following discussion with microbiology. The patient was given a heel offloading post-op sandal to wear.

At 4 weeks, many of the beads had come away from the wound during dressing changes but the wound was granulating and had significantly reduced in size.

At 5 weeks, the patient experienced increased bleeding and a haematoma was removed. Additional STIMULAN beads were loaded into the wound and oral antibiotics were discontinued.

The patient was assessed in clinic weekly and the dressing changed regularly. Further STIMULAN beads were added at 7 weeks, 9 weeks and 11 weeks.

At 14 weeks, the wound contained no STIMULAN and it’s size had reduced to 32mm x 15mm.

Outcome

At 7 months, the wound had almost closed and the patient no longer experienced pain from this area. Amputation was avoided and the patient was happy with the outcome. At 12 months the patient remained infection free.