Foot notes China

Two interesting case reports from China

Case 1

A 56-year-old man with an 18-year history of diabetes and resulting foot neuropathy presented at the hospital with ulcers of 3 months duration caused by burn in both plantar areas of his feet (Figure 1A and B). He did not feel any burning sensations for more than 3 hours when he put both his feet on a heat brick bed in a no deliberate manner. The patient had not known that he was severely burned until there were lots of water vacuoles on his feet. Then he tore the dermal of the bubbles on his left foot, and the foot began to become severely exudated-swollen wounded. The exudate increased, with color changing from yellow-white to olive green, and there were several black eschars in both feet. After admission, laboratory tests showed white blood cell 8.9 × 109/L, albumin 31 g/L, hemoglobin 75.2 g/L, Ankle–Brachial Index 0.9 (left) and 0.8 (right), and body mass index 16.4. Examination revealed severe infection of Aeruginosus bacillus and Saccharomyces cerevisiae on his left foot. First and most importantly, we gave him optimized nutritional support, which was 40 calories per kilogram of body weight (carbohydrates 60%, fat 20%, protein 20%), and moderate glycemic control (ADF standard, HbA1c < 6.5%), sensitive antibiotics to manage infection, aggressive and appropriate dressing change, instead of aggressive debridement of eschars. After albumin and hemoglobin levels returned to normal and swelling in both feet became normal, repeated limited debridement was carried out step by step, combined with continuing dressing changes and long-time antibacterial therapy for 3 months at the hospital, after which the ulcers on both feet healed completely (Figure 1C and D).

footnotechina1

This case was published earlier in the International Journal of Lower Extremity Wounds, 2012

Authors: Dr. Yufeng Jiang, MD, Professor Zhangrong Xu, MD, and Professor Xiaobing Fu, MD, PhD.
Contact Prof Zhangrong Xu: xzr1021@vip.sina.com
June 2014

Case 2

A 59-year-old man with a 16-year history of diabetes was admitted with a swollen right foot, 2 abscesses on the plantar area, for 10 days (Figure 2E and F). Physical examination revealed the following: temperature 38.6°C, heart rate 102 beats per minute, the third toe was gangrenous, and the second and fourth toes appeared dark orchid. Soon after admission, aggressive debridement was administered (Figure 2G and H), and glycemia was controlled to a moderate level (ADF standard, HbA1c < 6.5%). Then digital subtraction angiography test showed that there were stenosis in the middle of the right superficial femoral artery and anterior tibial artery and the peroneal artery. The posterior tibial arteries could not be visualized (Figure 2I and K). Then vascular intervention (stents and deep balloon angioplasty) was performed. The wound could be treated only after the foot got enough blood perfusion (Figure 2J and L). Negative pressure wound therapy was subsequently used on the wound to form a better wound bed. After that the wound bed was prepared satisfactorily, the skin transplantation operation was completed successfully (Figure 2M and N).

footnotechina2

This case was published earlier in the International Journal of Lower Extremity Wounds, 2012

Authors: Dr. Yufeng Jiang, MD, Professor Zhangrong Xu, MD and Professor Xiaobing Fu, MD, PhD.
Contact Prof Zhangrong Xu: xzr1021@vip.sina.com
June 2014