Question:
Can anyone tell me where I can find information about different causes
or conditions that may cause these ulserations. My wife has had these
for 15 years now and now they have gotten bad and the doctors can't
tell us what is going on. We are at our witts end as what to do next.
She hasn't been able to work for 5 months now and we need some
answers.


Answer:
Where are her ulcerations? When did she first develop them? Is your
wife a diabetic? What do they look like? Tell us more


Answer:
they are on her feet and left lower leg. She has had these for about 5
months and was healling ,but now is starting to regress. Yes she is a
diabetic, but the doctors say its not causing them. Email me and I can
show you some pics of the sores


Answer:
The circulation in your wife's legs may be poor. What type of doctor
is treating her? She should see a vascular surgeon for his opinion.
There is some type of insufficiency causing them and you need answers.
How is your wife treating her ulcerations?


Answer:
Hey dewhead, how are you doing?

Treatment of foot ulcers includes treatment of the diabetes itself. Management of contributing systemic factors, such as hypertension, hyperlipidemia, atherosclerotic heart disease, or renal insufficiency, is crucial.

Management of arterial insufficiency, treatment of infection with appropriate antibiotics, offloading the area of the ulcer, and wound care are also essential. Diabetic foot ulcers occur as a result of a variety of factors.

Such factors include mechanical changes in conformation of the bony architecture of the foot, peripheral neuropathy, and atherosclerotic peripheral arterial disease, all of which occur with higher frequency and intensity in the diabetic population.

However, significant atherosclerotic disease of the infrapopliteal segments is particularly common in the diabetic population. Underlying digital artery disease, when compounded by an infected ulcer in close proximity, may result in complete loss of digital collaterals and precipitate gangrene.

The reason for the prevalence of this form of arterial disease in diabetic persons is thought to result from a number of metabolic abnormalities, including high low-density lipoprotein (LDL) and very-low-density lipoprotein (VLDL) levels, elevated plasma von Willebrand factor, inhibition of prostacyclin synthesis, elevated plasma fibrinogen levels, and increased platelet adhesiveness.

The management of diabetic foot ulcers requires appropriate therapeutic footwear, daily saline or similar dressings to provide a moist wound environment, debridement when necessary, antibiotic therapy if osteomyelitis or cellulitis is present, optimal control of blood glucose, and evaluation and correction of peripheral arterial insufficiency. Wound coverage by cultured human cells or heterogeneic dressings/grafts, application of recombinant growth factors, and hyperbaric oxygen treatments also may be beneficial at times.

Offloading of the ulcerated area is imperative. This may require bed rest acutely.

Custom footwear or custom clamshell orthosis (for severe deformities) or total contact casting (a fiberglass shell with a walking bar on the bottom) are required for patients who are ambulatory. Diet is diabetic and low in saturated fat.

For the most part, diabetic ulcers are managed in the outpatient setting, with brief hospital stays often occurring for initial evaluation and debridement, subsequent vascular procedures, and, possibly, flap or skin graft wound management.

Hyperbaric oxygen therapy may be beneficial in certain cases of intractable foot ulcers accompanied by uncorrectable arterial insufficiency.

Best wishes,



The Prison Hospital

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