Fig.1 Day 1; tendon exposed diabetic foot ulcer
The patient was using regular gauzes to dress the ulcer, but the tendon
was at risk of dehydration tensions and necrosis. The patient was
referred to a surgeon for surgical treatment, but due to his
cardiovascular conditions, the medical team decided to perform
non-surgical methods.
In order to manage diabetes; Initial laboratory results indicated a
HbA1C of 9.2% and mean blood glucose of 226mg/dl. Synoripa 5/500 BD and
daily dose of Gliclazide 30 mg were prescribed. The wound care nurse
provided education on off-loading and diabetic diet tips. By the
10th day, the fasting blood sugar returned to the
normal range. Dressing of the ulcer using silver dressings and hydrogels
commenced, and betaine-polyhexanide solution was used as a proper
disinfectant in every dressing session. After 20 days of every two days
dressing, the healing process seemed to be very slow. Considering the
tendon-exposed, time was extremely vital for the medical team to save
the tendon by granulating the ulcer. Therefore, as the ulcer had a
margin of granulated tissue, 0/5 gram of collagen powder along with
Phenytoin ointment was used each session to boost the granulation
process. Furthermore, as complementary treatment, the patient underwent
ozone therapy by 70 mcg/dl(1). Local ozone therapy was conducted using a
plastic tent on the patient’s foot over 24-days period in 12 sessions.
By the day 44, the ulcer was totally granulated, and the Achilles tendon
seemed to be safe (figure.2).