Francis Derk1, Mike Griffiths2 1South Texas VA Medical Center (San Antonio, United States) 2AOTI (Oceanside, United States)

1. Francis Derk1, Mike Griffiths2
1South Texas VA Medical Center (San Antonio, United States)
2AOTI (Oceanside, United States)

2. A 66 yr/o Male underwent a
Femoral-Popliteal Bypass for a
non healing right dorsal foot
wound.
Infection Assessment:
Hospital Course: x 1
week (WBC 14.2)
IV antibiotics: Zosyn
(3.375 gms IV q 6 hrs)
x 6 days
C&S: Staph aureus
(negative MRSA)
X-rays: negative
Assessment:
PMH: PVD, HTN,
Obstructive Chronic
Bronchitis
Smoking: 1 PPD /
40 pack year hx
0
0.2
0.4
0.6
0.8
1
Right
Pre
Bypass
Right
Post
Bypass
Left Pre
Bypass
Left
Post
Bypass
ABI
TBI

3. Eight days following the procedure, the patient
developed right lower extremity thrombosis
resulting in the formation of deep sub dermal
eschars.
The patient was admitted for leuckocytosis and
wound management.
Patient exhibited multiple wounds on the dorsum,
medial and lateral ankles, as well as on the heel
Right Pre
Bypass
Post Bypass
S/P 2 months
ABI .44 .81
TBI 0.0 .49

4. Post debridement,
the patient was
discharged on an
antibiotic regimen and
was treated at home
for 90 mins BID with
a combination of
Topical Wound
Oxygen Therapy and
Collagenase Ointment
Dressings
Infection Management at Discharge:
Amoxicillin (250 gms qid x 14 days)
WBC: 6.7 / Sed Rate 20 / CRP 1.5

5. 3 weeks Topical Wound
Oxygen Therapy 90
min/BID and Collagenase
Ointment Dressings

6. 6 weeks Topical Wound
Oxygen Therapy 90
min/BID and Collagenase
Ointment Dressings

7. 10 weeks Topical Wound
Oxygen Therapy 90
min/BID and Collagenase
Ointment Dressings

8. Healed at 16 weeks Topical
Wound Oxygen Therapy 90
min/BID and Collagenase
Ointment Dressings

9. Topical Wound Oxygen Therapy combined with
Collagenase ointment dressings proved to be very
effective in this very unique case and a appears to
be a viable option in the treatment of ischemic
wounds.