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

Chronic wounds and facilitating their healing with Growth factors-

EGF, PDGF in non healing ulcers.

Growth factors such as EGF ( Epidermal growth factor), PDGF ( platelet derived growth factor) have been found to be useful in improving the wound healing. These are available in gel forms to applied after controlling the wound infections. Arterial ischemia, neuropathy, venous insufficiency are common in those non healing ulcer to different degrees. Correction is possible in some patients but in few the correction of them is partial or may not be possible. In such cases, we need to consider the growth factors such as these to facilitate and enhance the healing rates. Probably these growth healing help in shifting wounds from one stage to the other that is from inflammatory to the proliferative and from there to the maturation phase when the native wound growth factors fail to do so, due to the underlying pathophysiological changes. In India, these two growth factors are available in the market for use and are also affordable.

by

Pinjala R K

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