PCP referred patient to wound clinic where wound was debride | Figure 1

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PCP referred patient to wound clinic where wound was debrided. Pictures were taken 2 days after starting daily treatments with santyl. Lesion on big toe is on the same leg. Patient is scheduled for test to assess blood flow.

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Skill saw to thigh, was irrigated and washed, wound was successfully closed. Patient given antibiotics and discharged with instructions to follow up with primary provider.

This patient has DMT2, peripheral neuropathy, an absent posterior tibial pulse, and a 15 month history of an ulcer and osteomyelitis on the 1st metatarsal head. The patient refuses to attend a specialist wound clinic or hospital. Picture 1 is before debridement (note the necrosis where the wound is tracking to the toe webspace), picture 2 is after debridement. I am curious about the wound surface circled in yellow - it feels spongy and looks like there are many prominent capillaries.

89+ male was admitted to rehab following a traumatic injury to his left ankle. PMH of: DM Type 2 (non-insulin dependant), Cardiac Artery Disease, Peripheral Vascular Disease, DLP, HTN, and Hypothyroidism. Wound care specialists from the acute hospital previously prescribed idosorb ointment, adaptic, with pressure irrigation daily. After using their wound treatment for a few days, I found out it was not working for the patient. I decided to switch to intrasit gel to right fibrinous part of the wound and Aquacel Ag+ to the remainder of the wound, covering with Aquacel foam. As the wound progressed, I switched to only intrasit gel and covering with Aquacel foam. Progression of the wound is over a month and half. Last picture is a few days before the patient being discharged home with community nursing wound care services.

Stab wound auto-inflicted in cervical region, Zone II and at left. Patient presented hemathemesis in Emergency Department and submitted to OR.