Non-healing Ischemic Ulcer on the Dorsum of Foot

Fig: Non healing ulcer

This type of ulcers are difficult to manage and fail to heal with the usual measures such as local wound care and improvement of micro circulation (drugs). This patient (58 yrs) had Femoro-popliteal bypass in the past (10 yrs back) and that was blocked in the due course of time with development of tibial vessel disease. He received Injection Heparin, PGE-1 infusion, antiplatelet drugs and statins. It failed to heal and rest pain persisted ( 2 years). The tibial vessels were not suitable for any type of distal bypass. The heal of the foot is healthy and so are the toes as seen the photograph.

1. What further treatment can be offered in this patient for healing of ulcer and relief of pain?
2. Would like to consider any type of amputations?
3. Any special Endovascular therapies?

By Pinjala R K