Diabetic with Traumatic Flap Wound

This 55 year old patient with Diabetes Type 2 had dropped a piano frame onto his (R) lower leg resulting in a large flap laceration. He was sutured in the local emergency department and was referred to the hospital’s outpatient wound clinic.

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Wound failed to show signs of healing

However after six weeks, the flap had died-back and the remaining wound had failed to show signs of healing despite competent wound care. Transcutaneous oxygen measurements in the surrounding tissue were relatively normal, breathing 1 ATA air. Considering the patient’s medical history and the likelihood of further complications hyperbaric oxygen was indicated and commenced.

 

 

 

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3 areas of undermining present

On presentation, there were 3 areas of undermining present surrounding the wound’s edges. A wound culture revealed mixed coliforms and both gram positive cocci and gram negative bacilli.

 

 

 

 

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After 26 hyperbaric treatments

After 26 hyperbaric treatments, the wound appeared clean, with healthy granulation tissue present. The surrounding skin also had improved and the wound was no longer undermined. He was referred to a plastic surgeon for a skin graft.

 

 

 

 

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4 weeks later completely healed

He returned 4 weeks later with complete healing and resumed work earlier than planned.