Podiatrist - Portland
15 Sewall St
Portland, Maine 04102
207-774-0028
WOUND ATLAS
I have found over the years, I really like to treat wounds, especially diabetic wounds. There is something very satisfying about watching an ulcer transform into new skin.
There are several types of wounds.
- Venous stasis ulcers
- Diabetic neuropathic ulcers
- Ulcers secondary to peripheral vascular disease
- Traumatic ulcerations
- Post surgical wounds
Small venous stasis ulcer
These ulcers are caused by blood pooling in the legs due to venous insufficiency. Treatment for venous stasis ulcers include treatment of infection, controlling drainage, debridement and compression dressings or stockings and possibly grafting. These wounds can take many months to heal and can be quite frustrating. Patients with these types of wounds may benefit from laser or radiofrequency ablation of incompetent veins. Fortunately this patient is on her way to healing.
Diabetic infected neuropathic ulcer
Infected diabetic neuropathic ulcer
This ulceration was caused by friction and pressure in an uncontrolled diabetic. Treatment included antibiotics, debridement, wound care, offloading by taking pressure off the ulcer. The patient achieved control of his blood sugar with diet and adding insulin to his oral medication. The ulcer eventually went on to heal with an Apligraf and wound care. Prevention of future ulcers is achieved with periodic visits and extra depth diabetic shoes with diabetic inserts.
Non infected diabetic neuropathic ulcer
This patient has a non painful ulcer of the plantar surface of her foot. Unfortunately she has already lost her other leg.
Neuropathic ulcer on the great toe
This ulcer was caused by lack of sensation to the feet from neuropathy without diabetes. Treatment for this ulcer is similar to those with diabetes, offloading, diabetic inserts, shoe modifications, wound care, debridement and antibiotics if necessary.
Ischemic ulcer/gangrene fourth toe
This wound is due to loss of blood flow to the small blood vessels causing the tip to turn black. There are ischemic changes to the third toe as well. This patient has a history of tobacco abuse, high cholesterol and Raynaud's disease. Treatment includes referral to a vascular surgeon for possible revascularization, smoking cessation, amputation and antibiotics for infection. Hyperbaric oxygen can also be a treatment option.
Traumatic Wound
Traumatic wounds can lead to infection in the bone. In this photo the end of the second toe is enlarged and swollen secondary to a chronic bone infection. Treatment includes local amputation and antibiotics. The patient went on to heal very well after removal of the end of his toe.
Chronic Osteomyelitis First Toe
Here is an example of chronic osteomyelitis in the great toe. The wound bed is red and granular but centrally the wound probes to bone. Swelling and scaling around the nail plate also suggest chronic infection. Treatment is amputation and antibiotics. Patient is status post 2 months amputation on the right. The patient may develop hammertoes of the lesser toes which may be treated by cutting the tendons to the bottom of the toes.
Post Surgical Wound
This patient had a first ray amputation for acute osteomyelitis of the first metatarsal. The wound was left open to insure that the infection had resolved and allowed to granulate by secondary intention with a VAC dressing. The wound is ready for a biologic graft.
Pre-ulcerative callus in patient with diabetes and hammertoe. The callus is considered pre-ulcerative due to the dried blood in the callus. The patient a percutaneous flexor tenotomy of the second toe in the office. The picture on the right show the toe one week after the procedure.