Keywords
Diabetic Foot Ulcers, Wound Management, Ozone Therapy
Introduction:
Diabetic foot ulcers (DFUs) cause a significant challenge for diabetic
patients, with a heavy economic and health burden on both the patients
and their family(1). Patients condition become more vulnerable when
there is a risk of amputation and tissue loss. Despite microcirculatory
dysfunctions and neuropathic complications in diabetic patients, older
adult patients are more susceptible to DFU and its consequences due to
degenerative effects of aging(2). surgical interventions such as
secondary flap prostheses or other plastic surgery methods is needed to
treat high-risk DFUs. Indeed, older adults with cardiovascular diseases
or ages above 70 years have limitations to perform surgical methods,
which forces wound therapist and the medical team to choose non-surgical
methods(3).
In this case, we report a high risk tendon exposed DFU healed by ozone
therapy and collagen powder and phenytoin ointment.
Case presentation:
The patient, a 73-year-old Iranian male with uncontrolled diabetes
mellitus, presented with a large diabetic ulcer on his right foot’s
Achilles tendon that had been present for three months (figure.1). The
patient had a history of heart failure with an ejection fraction of 30%
and previously undergone angiography and pacemaker insertion. He had
been self-administering metformin (500 mg, BD) for the past seven years,
and scars on other parts of his foot indicated a history of multiple
healed ulcers.
Upon examination, the patient presented with a Wagner II,
tendon-exposed, non-infected ulcer measuring 10 cm in length and 4.2 cm
in width, with 9.5 cm of Achilles tendon exposed out of the tendon
sheath. The condition had deteriorated due to previous unnecessary
surgical debridement, and the ulcer had only a few granulated tissues in
the wound edges, with most of the ulcer occupied by the tendon.