This was an 86 yr. old house call patient with NIDDM and end stage bladder cancer. He had PVD. He was seen for routine diabetic foot care and a right heel ulcer in 1999. This ulcer took many months to heal with normal conventional therapy.

Later in January of 2003 he was placed in a nursing home with end stage bladder cancer and a fracture of his right femur, which was treated for with a long leg plaster cast. Due to the diabetes, PVD and his poor nutrition upon cast removal six vascular decubitus ulcers had formed. The medial ankle and the right 5th metatarsal - the base and head had two areas of bone all exposed.

Photos are in progressive stages of healing for the six ulcers. Ulcers were debrided and cleansed with normal saline solution weekly. Silver impregnated dressings were used in the beginning on the ankle areas. The lateral ankle healed and later the combination of hydrogel and Amino-pPlex® spray was used every other day on the remaining ulcers.

Although the patient was infected and treated appropriately with antibiotics, the prognosis for healing was dim because bone was protruding and out of the medial ankle ulcer and the two ulcers on the lateral side of the foot. These are considered a grade IV, and osteomyelitic, and very difficult to heal.

In viewing the healing until December when the patient died, all the ulcers with bone protruding out were completely healed, using the aminoplex and hydrogel combination. However he did develop gangrene of the distal 3 toes midway through the treatment which attests to his severe circulation impairment.

Surprisingly the demarcation site of the gangrene also started to heal and become less odorous with the Amino-pPlex® spray used with the regular dressing treatments. I personally have never seen anything like this before.

DR. HONOR G. MANILLA