Against Most Odds: A Case Report, Limb Salvage

Introduction: In the U.S., 24.4 million people are diabetic. Thirty-three percent of the cost of treating diabetes is linked to the treatment of diabetic foot ulcers. Despite treatment, 30% of diabetic foot ulcers fail to heal in 20 weeks. Diabetic foot ulcers are the most common cause of nontraumatic lower extremity amputations. Eighty thousand amputations are done annually, which is associated with higher mortality rates. This is a public health crisis with great social impact.

Case Study: A 64-year-old diabetic male with arterial disease presented with a right gangrenous toe. He was referred to vascular service and underwent right femoral tibial bypass and amputation of the toe. Shortly thereafter, he developed an ischemic right foot and underwent a transmetatarsal amputation. HBOT was initiated. Within two weeks, the flap started to fail. The patient continued HBOT, and a VAC was placed to the failed flap site. After 11 HBOT treatments, the patient refused treatment due to confinement anxiety and poor tolerance of anti-anxiety medication. As adjunct therapy, HBOT raised the vascular bed and prepared the site for grafting. Omega-3 fish skin is a new skin substitute rich in naturally occurring omega-3 polyunsaturated fatty acids from wild Islandic cod. The fish skin has the same structure as human skin. The substitute was placed to the failed graft site weekly x 3, at which time the wound was fully granulated. An iodine-containing topical dressing was used until closing. Blood glucose was closely monitored throughout.

Conclusion: The coordination of care, collaboration, and expertise of a limb salvage team is extremely important, utilizing conventional, adjunct, and novel therapies. Access and commitment to care plan by both patient and limb salvage team can achieve a successful outcome. After six months of treatment, the patient was discharged with supportive shoe and toe filler.