Case 142: Painful Intractable Leg Ulcers Healed in Outpatient Clinic

This 75 year old female ex-smoker bumped her leg against a car door in June 1980. Her abrasion enlarged over three to four months in spite of the treatments of her family doctor. She was then referred to a surgeon who attempted outpatient therapy only to find that another leg ulcer developed from a separate scratch. She was then hospitalized for three weeks where in spite of antibiotics, whirlpool treatments and the local care of her surgeon, her painful ulcers would not heal. She refused to have an arteriogram. She was discharged and was visited every other day by her surgeon or his assistant. She was then referred for boot therapy.

June 9th, 1981

Her initial culture grew out a Proteus Mirabilis for which she was given oral ampicillin. As she refused to allow a blood pressure cuff placed around her ankle, serial calf pressures were followed. She was given 23 outpatient treatments between June 9th and August 6th when she was healed. Her blood pressures were respectively on June 9th, 19th and August 6th: 192/93, 170/85 and 154/80 in her arm; 0, 20 and 76 in the anterior tibial; 96, 130 and 112 in the posterior tibial; and 106, 110 and 118 in the peroneal artery at the calf. She returned November 2nd with another small abrasion (2nd picture) which rapidly healed with a few more treatments. Her leg remained healed until her death a few years later.

November 2nd, 1981.

Comments: This lady likely had both venous and arterial disease. She responded nicely to Long-Boot therapy to the whole leg. Wet-to-dry dressings with Sea Soaks and gentamicin were applied over her ulcers during her treatments. If such treatments are painful, Lidocaine may be added to the Sea Soaks to anesthetize the lesion. It would have been interesting to know what her ankle/arm index was. If she had agreed to an arteriogram and a correctable lesion were visualized, her surgeon would have recommended vascular reconstruction. She did well without it at a much less price.