Case 168: Outpatient Healing of Ulcer in a Foot with a TcPO2 of Zero

This 69 year old type 2 diabetic man was treated for an ulcer on the side of his foot for six weeks with Cipro. He was then hospitalized and treated with intravenous heparin and Vancomycin and oral Flagyll for ten days under the care of his family doctor, an infectious disease consultant and a general surgeon. Failing to heal but appearing stable, he was discharged and given a consult for boot therapy on January 3rd, 1994. He was found to have monophasic Doppler sounds at the ankle, an ankle/arm index of 1.21 and a transcutaneous PO2 level of zero on the dorsum of the foot. Among his subsequent cultures were yeast and a methicillin-resistant Staphylococcus aureus. He was treated in the Mini-Boot as an outpatient with his foot immersed in Sea Soaks containing gentamicin, Vancomycin, Fungizone and Urecholine. Bactrim-DS and doxycycline were the oral antibiotics used during his treatment.

He healed and returned to an ambulatory state. As of March 10th, 1998, his foot has remained intact and he has been fully active.

Comments: His ABI of 1.21 of course was misleading. The patient with medial calcinosis, of course, can have a high ankle blood pressure as the blood pressure cuff cannot compress a calcified vessel. With a TcPO2 of zero, he would presumably never have healed without some form of therapy that improved blood flow to his foot.