Case 6: Inoperable ASO in Transplant Patient

Progressive Ischemic Necrosis on Presentation

This 35-year old woman had had diabetic nephropathy and retinopathy. The former had been treated with hemodialysis and subsequently renal transplantation. The latter had required laser therapy. 3/28/93 her toes began to necrose. Her University vascular surgeons found no opportunity for vascular reconstruction in either leg. No Doppler flow was detected in the dorsum of either foot. She was referred 6/10/93 for boot therapy with a mummification of the entire right 5th toe, of parts of the right 1st, 2nd and 3rd toes and of parts of the left 1st and 4th toes (first picture - Progressive Ischemic Necrosis on Presentation). Small areas of focal necrosis were also present on the left 2nd and right 4th toes.

Both of her feet were treated in the Miniboot on an outpatient basis. The mummified portions of her toes were clipped off in the office and then cut back to leave a thin rim of eschar. Multi-electrolyte solution containing Urecholine and antibiotics were used within the Miniboot. When her feet were shown to be obviously responding to the therapy, her husband was trained in the boot procedures and she was thereafter treated at home. No additional tissue was lost and both feet healed leaving her fully ambulatory. (Second picture)

Comments: The university vascular surgeons of this patient advised that leg amputation was inevitable and the best course to relieve her pain. She did well with boot therapy and, had it been begun earlier, she might not have lost any toes.

Nine Months Later Both Feet Well