Case 49: Leg Ulcers post Aortic Balloon and Ineffective Distal Bypass Successfully Treated with Boot

This 81 year old obese lady had had coronary artery bypass surgery in August 1987 when an aortic balloon was inserted into her right femoral artery. Her leg subsequently cooled and developed multiple ulcers above the ankle. An in-situ bypass into her peroneal artery did not improve her distal flow. She was referred for boot therapy with the painful ulcers shown in the first two photographs.

Post Bypass - Sutures Out and Incision Healing Well except in the Groin - Painful Lower Leg Ulcers

Multiple Ulcers, Some Red but a Large Central Ulcer with a Necrotic Base

She was treated with local antibiotic-Sea Soaks compresses and Long-Boot therapy and developed good granulations, which to the surgeons invited skin grafting. The latter was accomplished. The donor sites provided an opportunity to challenge the plastic surgeons as to who could heal the donor sites faster, the boot service with Sea Soaks compresses or the plastic service with their usual Scarlet Red patches and heat lamps. (It probably would have been fair to include heat lamps over the Sea Soaks compresses also but that was not done.)

Early Postoperative State - Sea Soaks Compresses Applied on Left and Scarlet Red Patch on Right

Her lower leg did well. The groin incision was infected and later was also treated with local Sea Soaks-antibiotic compresses. Both donor sites healed. We thought the Sea Soaks did better. What do you think?.

Ankle Grafts Taken, Donor Site Healing and Groin on Wet-to-Dry Sea Soaks

Grafts Taken and Adjacent Skin Color Improved

Donor Sites at Time of Discharge to Care of Visiting Nurse

Comments: The arterial flow became compromised in the lower leg after the use of the aortic balloon possibly due to proximal vascular injury, distal thrombosis associated with an impairment of distal flow while the balloon was in place or distal emboli. Bypass did not reverse the situation and was associated with a proximal groin infection. Did you agree that Sea Soaks did a better job than the heat lamp and Scarlet Red compresses?.