What comprehensive care is required for elderly diabetic cellulitic ulcer patients?
Figure A: Toe ulcer of a 70-year-old man with type-2 diabetes, first seen with an infected cellulitic toe ulcer. This figure depicts the wound after intravenous antibiotics and surgical debridement.
Figure B: Patient’s toe ulcer healed after early comprehensive treatment. There should never be an exception to proper wound-bed preparation (i.e., early surgical debridement in a diabetic foot ulcer and treatment with anti- biotics targeted directly toward bacteria growing from the deep culture) because a patient is elderly. The elderly can heal if provided with early intervention and comprehensive care.
Figure C: 82-year-old patient with diabetes first seen with a venous stasis ulcer of an 18-month duration that started after a vein was harvested for coronary arterial bypass grafting. Costs for daily nursing visits regarding this patient’s wound treatment alone totaled over $70,000. Doppler ultrasound confirmed venous reflux. No data exist that patients with diabetes and venous reflux have a different rate of healing.
Figure D: Note bilayered human skin equivalent (HSE) (cultured keratinocytes and fibroblasts on type-1 collagen) being applied to the venous ulcer. Appli- cation was administered in an office setting with a 1-mm distance left between debrided healing skin edge and new bilayered HSE.
Figure E: Venous stasis ulcer healed at 7 weeks.
Figure F: Wound is contracting and epithilalizing. Important to note is that even ischemic, infected wounds in the elderly (this patient also had venous reflux and took systemic steroids) are expected to heal as long as comprehensive treatment is initiated immediately.
Harold Brem, M.D., Alina Tarnovskaya, B.A., Edwin Baskin-Bey, M.D., Miriam Carsa, ED.D., C.N.A., Hyacinth Entero, B.A., Marjana Tomic-Canic, Ph.D., H. Paul Ehrlich, Ph.D., Kiran Gill, B.A., Sarah Weinberger,D.E.C.