Francis Derk1, Mike Griffiths2

1South Texas VA Medical Center (San Antonio, United States) 2AOTI (Oceanside, United States)

A 66 yr/o Male underwent a Femoral-Popliteal Bypass for a non healing right dorsal foot wound.

Infection Assessment: Hospital Course: x 1

week (WBC 14.2) IV antibiotics: Zosyn

(3.375 gms IV q 6 hrs) x 6 days

C&S: Staph aureus (negative MRSA) X-rays: negative

Assessment: PMH: PVD, HTN,

Obstructive Chronic Bronchitis

Smoking: 1 PPD / 40 pack year hx

0

0.2

0.4

0.6

0.8

1

RightPre

Bypass

RightPost

Bypass

Left PreBypass

LeftPost

Bypass

ABI

TBI

Eight days following the procedure, the patient developed right lower extremity thrombosis resulting in the formation of deep sub dermal eschars.

The patient was admitted for leuckocytosis and wound management.

Patient exhibited multiple wounds on the dorsum,

medial and lateral ankles, as well as on the heel

Right Pre Bypass

Post Bypass S/P 2 months

ABI .44 .81

TBI 0.0 .49

Post debridement, the patient was discharged on an antibiotic regimen and was treated at home for 90 mins BID with a combination of Topical Wound Oxygen Therapy and Collagenase Ointment Dressings

Infection Management at Discharge: Amoxicillin (250 gms qid x 14 days)

WBC: 6.7 / Sed Rate 20 / CRP 1.5

3 weeks Topical Wound Oxygen Therapy 90

min/BID and Collagenase Ointment Dressings

6 weeks Topical Wound Oxygen Therapy 90

min/BID and Collagenase Ointment Dressings

10 weeks Topical Wound Oxygen Therapy 90

min/BID and Collagenase Ointment Dressings

Healed at 16 weeks Topical Wound Oxygen Therapy 90 min/BID and Collagenase

Ointment Dressings

Topical Wound Oxygen Therapy combined with Collagenase ointment dressings proved to be very effective in this very unique case and a appears to be a viable option in the treatment of ischemic wounds.