Practice of Diabetology Carola Zemlin M.D., Wanzleben/Germany
Anamnesis
72 years old, male, type 2 diabetes mellitus, diabetes diagnosis 1977, insulin therapy with 2x combination insulin 30/70. Coronary heart disease, nephropathy (dialysis needed), diabetic neuropathy with diabetic neuropathic osteo-arthropathy.
State after amputation of the right lower leg and the 1st and 2nd left toe. Perforating ulcer with protection on the 2nd and 3rd metatarsal bone since three years. Altogether 9 month of hospital stay, wound treatment ambulant and stationary with common salt irrigations and several insertions of Septopal mini chains.
Actual findings at 1998/07/15
Perforating ulcer of 18x16mm with inserted Septopal chain.
Fig. 1: 1998/07/15
Fig. 2: Progress
Fig. 3: Closure after four weeks
Removal of the Septopal chain with the forceps, under it the structur of the metatarsal bone is visible. Assuming that this is a sequestrum, careful attempt of removal with Luer´s bone nibblers. But the assumed sequestrum is the osteomyelitic mutated part of the 2® metatarsal bone. After irrigation of the wound with Lavasept a 2 cm deep cavity remains, that is treated with sterile LIGASANO® white and irrigation with Oxoferin. Closure within four weeks.
Additionally we made a special cast at the first day of treatment. A supply with orthopedic footwear takes place after closure of the ulcer.
Study about the use of LIGASANO® white as initial wound dressing at foot disease caused by diabetics, of Carola Zemlin, M.D., internist/diabetologist. For the evaluation of the study please click here.