History:

The patient is a 36 year old female with an unremarkable past medical history and no known drug allergies. She relates to smoking one-half pack of cigarettes per day. This patient first presented to our office in November of 2008 after suffering an acute open fracture and contusion of her right 5th digit with disarticulation of the distal interphalangeal joint. The patient underwent lavage and delayed primary closure of her fifth toe.
This patient followed standard post-operative course and regular visits with viability of the distal aspect of the 5th digit questionable.
At the eight week post-op mark incisions were healed however exposed bone remained at the distal-medial aspect of the 5th digit right foot. At 14 weeks the decision was made to perform amputation of the 5th digit on the right foot due to exposed bone and osteomyelitis that did not respond to local wound care. On March 13, 2009 the patient underwent amputation of the 5th digit right foot. At the six day post-op mark the patient had a mild infection at the surgical site and was treated successfully with antibiotics and patient performed daily dressing changes with betadine due to a small area of dehiscence at the incision site. At two weeks status post 5th digit amputation the incision site was dehisced however with excellent granulation tissue noted and no erythema to the site. At this time the patient was started on daily dressing changes with Wound-Be-Gone.® Four weeks status-post 5th digit amputation of the right foot the wound was completely closed with an excellent result and the patient is to return to our office as needed.

History:

The patient is a 23 old female with past medical history of insulin dependent diabetes mellitus and reported allergy to adhesive tape. This patient has been seen for previous ulcerations over the past two years and most recently for a new ulceration at the plantar aspect of the first metatarsal-phalangeal joint of the right foot on February 10, 2009. The patient was originally treated with in-office debridement, off-loading pads, and iodoflex. Patient presented with evidence of gas gangrene on February 18th, 2009 and was admitted to the hospital. On February 19th, 2009 the patient underwent incision and drainage of the ulcerative site right foot.The patient was discharged from the hospital on February 21st, 2009 and performed daily wet to dry dressings to the ulcerative site on the right foot. The patient presented for her first post-op visit on February 24th, 2009 and the wound had improved by decreasing in depth and measuring approximately the size of a quarter with an approximate 6.6 cm in length open incision site from surgery. On March 3rd, 2009 the patients wound measured 6.6 cm in length x 2.2 cm in width x 0.5 cm in depth.

• The patient was started on Wound-Be-Gone® application to wound with daily dressing changes and continual off-loading to the ulcerative site.


• On March 13th, 2009 the patient presented to clinic with wound measurements of 6.4 cm in length x 2.0 cm in width x 0.5 cm in depth and was instructed to continue "Wound-Be-Gone® dressing changes.


• The patient returned on March 27th, 2009 with significant improvement of wound site note.


• Measurements on this date were 2cm in length x 2 cm in width x 0.1 cm in depth.


• The patient will continue Wound-Be-Gone dressing changes. On April 10, the patient was healed.