Diabetic with a Traumatic Wound

A 58 year old diet controlled diabetic suffered a complex impact fracture to his left ankle with arterial involvement. He commenced HBOT 5 days post-injury after the wound had been cleaned and the fracture set with K wires.

Transcutaneous Oxygen measurements taken confirmed a hypoxic wound with readings of 35mmHg and 19mmHg breathing air at 1 ATA (40 – 50mmHg is considered the minimum threshold for normal wound healing). After 15 minutes of breathing 100% oxygen at 1 ATA the readings increased to 245mmHg and 223mmHg. This increase would indicate the hypoxia was correctable with a course of hyperbaric oxygen therapy.

Wound infected with a gram negative organism
Wound infected with a gram negative organism

The wound was found to be infected with a gram negative organism. There was also considerable concern about the viability of the blood supply to the injured are as the posterior tibialis artery had been severed in the accident. A dark necrotic area was already apparent.

 

 

 

After 10 treatments
After 10 treatments

After 10 treatments at 140 K p the wound has clearly defined viable tissue and appears much cleaner. At this stage the sutures were removed however, the K wires remained insitu for a number of weeks during his recovery.

 

 

 

During 19 treatments healing continued
During 19 treatments healing continued

Daily HBO was continued for 19 treatments. At
this stage granulation tissue filled the majority of the wound and healing continued by secondary intention, Over the next three months the K wires were removed and the patient commenced physiotherapy to regain movement in his ankle. Wound management continued in the Outpatient Wound Clinic twice per week.

 

 

Complete healing
Complete healing

The above picture shows complete healing of the injury five months to the day after the original injury. At that time he had approximately 80% range of movement and was continuing physiotherapy in order to regain further mobility.