title: Topical Therapy As Adjuvant Treatment to Save a Limb With Critical Ischemia From Extensive and Deep Diabetic Foot Infection When Revascularization Is Not Feasible.
abstract: BACKGROUND
  Patients with diabetes mellitus are susceptible to foot ulcerations associated with the complex triad of peripheral sensory neuropathy, vasculopathy, and trauma. Local infection of a diabetic foot ulcer (DFU) acts a significant deterrent to healing because the response to aggressive debridement antimicrobial therapy is limited when peripheral circulation is poor.
  
  
  METHODS
  We share an experience of using silver-impregnated hydrofiber wound dressing as an alternative to amputation in an 85-year-old female patient with an infected, ischemic DFU. This patient had a long-standing history of diabetes mellitus and hypertension for more than 30 years; both conditions were managed with oral medications. Penetrative injury caused by toothpicks resulted in 2 ulcers over the right lateral and medial plantar areas of her right foot. The DFUs were present within a period of 6 months. Due to the deep wound and progressively worsening infection, she was admitted for systemic antibiotics, debridement, and plantar fasciotomy. Percutaneous transluminal angioplasty was indicated, but the patient refused due to concerns related to potential nephrotoxicity associated with contrast use. Amputation was proposed as the final resort if the critical ischemia showed no improvement. Before undertaking amputation, silver-impregnated hydrofiber dressings were applied to the DFUs, along with antiplatelet medications. Following 4 months of treatment, the right medial plantar ulcer healed completely and the DFU over the lateral plantar ulcer was 75% smaller in surface area. Both DFUs remained healed when evaluated at 8 months.
  
  
  CONCLUSIONS
  We found that a silver-impregnated hydrofiber dressing, combined with antiplatelet medications, allowed the patient to avoid amputation despite 2 deep and extensively infected DFUs with critical limb ischemia when revascularization was not feasible.
authors.affiliation: Jen-Hsiang Shen, MD, Department of Plastic Surgery, Chang Gung Memorial Hospital, Chiayi Branch, Puzih City, Chia-Yi County, Taiwan and Department of Ophthalmology, Chang Gung Memorial Hospital, Linkou Branch, Tauyuan, Taiwan. Chin-Jui Liu, MD, Department of Plastic Surgery, Chang-Gung Memorial Hospital, Chiayi Branch, Puzih City, Chia-Yi County, Taiwan and Department of Otolaryngology, Chang Gung Memorial Hospital, Chiayi Branch, Puzih City, Chia-Yi County, Taiwan. Shun-Chun Lo, MD, Department of Plastic Surgery, Chang-Gung Memorial Hospital, Chiayi Branch, Puzih City, Chia-Yi County, Taiwan and Department of Otolaryngology, Cardinal Tien Hospital, New Taipei City, Taiwan. Yu-Tsung Chen, MD, Department of Dermatology, Shuang-Ho Hospital, New Taipei City, Taiwan. Chang-Cheng Chang, MD, Department of Plastic Surgery, Chang Gung Memorial Hospital, Chiayi Branch, Puzih City, Chia-Yi County, Taiwan and School of Medicine, China Medical University, Taichung, Taiwan.
authors.forename: Jen-Hsiang
authors.initials: JH
authors.lastname: Shen
authors.forename: Chin-Jui
authors.initials: CJ
authors.lastname: Liu
authors.forename: Shun-Chun
authors.initials: SC
authors.lastname: Lo
authors.forename: Yu-Tsung
authors.initials: YT
authors.lastname: Chen
authors.forename: Chang-Cheng
authors.initials: CC
authors.lastname: Chang
mesh_terms: D000369:Aged, 80 and over; D001458:Bandages; D002266:Carboxymethylcellulose Sodium; D003131:Combined Modality Therapy; D017719:Diabetic Foot / Q000382:microbiology / Q000473:pathology / Q000628:therapy*; D005260:Female; D006801:Humans; D007511:Ischemia / Q000209:etiology / Q000473:pathology / Q000628:therapy*; D023821:Limb Salvage; D010975:Platelet Aggregation Inhibitors / Q000627:therapeutic use; D018030:Silver Compounds / Q000627:therapeutic use*; D014665:Vasodilator Agents / Q000627:therapeutic use
chemical_list: D010975:Platelet Aggregation Inhibitors; D018030:Silver Compounds; D014665:Vasodilator Agents; D002266:Carboxymethylcellulose Sodium