Case 118: Recurrent Stasis Ulcers and Cellulitis Controlled by Home Circulator Boot

At age 31, this Klinefelter patient presented with complaints of painful leg stasis ulcers aggravated by his occupation as a hairdresser. He had a history of three varicose vein operations and one successful and one unsuccessful grafting procedure in his New York Hospital. He had seen many doctors and had not been able to successfully remain free of pain and varicose ulcers. At this time he had a 2.5 cm ulcer beneath his left internal malleolus and palpable thrombosed veins in the pigmented area of his inner lower leg. He was treated with Long-Boot therapy and local soaks and his ulcer healed. An arteriogram was done to rule out A-V shunts as a cause for his recurrent disease and was normal. Our orthopedic consultant performed a PIP fusion of his right third toe and metatarsal osteotomies of his right 2nd and 5th toes during this hospitalization.

He left the hospital a happy man with a healed ulcer, August 30th, 1981

Four days later he returned in pain complaining that the skin over his ulcer was about to peal off., September 2nd, 1981

He was hospitalized for possible phlebitis in his opposite leg, which had had the recent surgery. Bilateral venography showed previous venous ligations but no varicose veins in the left leg and no phlebitis was confirmed in the right leg. At the request of the patient, who was sure it was necessary to find lasting relief, his stasis ulcer was excised and a skin graft applied. Again, he was treated with the Long-Boot two to three times a day through his hospitalization. His graft healed and he was discharged home October 4th, 1981.

Over the next two years, he came to Philadelphia for occasional boot treatments when he thought his legs were getting sore and required no hospitalizations. Then on August 17th, 1983, his podiatrist pared some callus on his right foot and injected the area with dexamethasone. His leg became progressively sore over the next several hours leading him to the emergency room of his local hospital. Ampicillin was prescribed along with bedrest, elevation and heat compresses. His pain increased and on August 22nd he came to Bryn Mawr.

He had a small ulcer distal to his internal malleolus and obvious reddening and cellulitis in his posterior lower leg

He was treated the first day with continued bedrest, heat, antibiotics and elevation while his testing was accomplished; he experienced no pain relief. After normal venous Doppler studies, he was given 7.5 hours of continuous boot therapy. He claimed complete symptomatic pain relief and requested discharge to return to work. He was discharged the morning of the 3rd day.

His ulcer culture grew out Coagulase-negative Staphylococci that were resistant to ampicillin. He was discharged on Keflex.

He returned a month later for his fourth Bryn Mawr Hospital admission again with a swollen tender leg. Again, after normal venous testing, he was treated with the Long-Boot and antibiotics experiencing relief of both swelling and pain. As other physicians had done, we prescribed a Jobst Boot for home use along with Jobst stockings. These proved ineffective and he returned again to the office for occasional urgent boot treatments. He then purchased a Circulator Long-Boot system to treat himself at home. The latter has been quite successful and he has required no additional hospitalizations over the last 14 years..

Comments: This man was plagued by recurrent stasis ulcers and cellulitis. Other boots and other hospital treatment programs did not work for him. He has done well since he has had his own Circulator Boot system.

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