Case 23: Resistant Combined Stasis and Ischemic Ulcers Healed

At age 70 this lady was referred for boot therapy by friends. She had never smoked. She had type 2 diabetes. She was thought to have both peripheral arteriosclerosis obliterans and stasis disease. She had been unable to heal painful leg ulcers over three years and had been limited to her bed and wheelchair. She had been hospitalized for bedrest and heparin therapy without benefit. She was continued on coumadin. Her ulcers did not heal despite the manipulations of her internist and dermatologist. She was advised her ulcers were incurable. Her legs were firm and indurated, especially above the medial condyle of the knee. She had multiple palpable subcutaneous thrombi raising the possibility of pulmonary emboli with boot therapy. Because of her immobility and the threat of emboli, she was hospitalized to initiate her boot therapy..

Legs on Presentation

No signs of emboli were seen. She was treated with the Long- Boot from her groin to her toes 3-4 times daily. Fresh wet-to-dry dressings with Sea Soaks were applied before each treatment. Her legs were softened and her ulcers became free of pain. She was then transferred to our nursing home service to continue the treatments.

Legs on Transfer to Nursing Home

Ner legs did well at the nursing home where physical therapy was added to her program ... conditioning and gait retraining. The legs were softer, more pliable and healing.

Left Aspect of Legs

Right Aspect of Legs

She was discharged and was independent at home for two months when she fell down the stairs tearing the skin off her shins. She attempted home care for a few days before notifying us of her disaster and her inability to ambulate. She was again hospitalized at Bryn Mawr and stabilized.

Skin Tears Following Fall Down Stairs

She was again transferred to the nursing home boot service where she healed her shins. Subsequently, unfortunately, she contracted a severe influenza pneumonia, congestive heart failure and bedsores. She died two months later.

Legs Again Doing Well but a Debilitated Patient

Comments: This lady was deconditioned when first seen. She had multiple subcutaneous thrombi, firm tender indurated legs and ulcers. Standard therapies had failed her. The Circulator Boot in firmly squeezing her legs after every heartbeat, about 15,000 such squeezes a day, was able to break up her thrombi, restore normal tissue turgor and permit healing. It is helpful for the physician who is not familiar with our therapy to palpate such legs. A similar process likely occurs in thrombosed arteries... which unfortunately are not readily palpated. In this case, the ulcers were healed and the lady rehabilitated but not enough to have prevented her fall..