43 year old male, IDDM x 30 yrs. Presented to hospital with an infected right 5th toe and cellulitis, as a result of a tight ski boot.
Patient started on IV antibiotics, HBO therapy, appropriate wound care and offloading. No surgical interventions were done. Bone scan showed an osteomyelitis. Transcutneous oxygen mapping was performed. The results indicated the wound would not heal in an ambient environment as the partial pressures of oxygen were far below 30 mmHg. Wound care treatment was moist wound healing with debridement of wound and offloading the pressure. Dressings consisted of an Intrasite® Gel to base of wound with an Allevyn® dressing. A light compression with a Tubigrip® was used to decrease the edema to the leg. The dressings were changed every second day. A Darco® Boot was fitted to the patient’s foot for offloading of pressure at the wound site.
Patient underwent a course of 30 HBO treatments daily using a 90 minute treatment interval at pressures of 2.5 atmospheres absolute. Appearance of the wound after completion of HBO. The result was excellent salvage of the leg and toe. Patient continued on oral antibiotics for 1 month.
2 month follow-up: healing is complete.