ceptic ulcer

My mother, 89 years old has septic ulcer on her lower leg with approximately a diameter of 10 cm and about 3 - 4 cm deep.

it was treated in hospital with intravenous penicillin and followed up by oral antibiotics.  Daily the wound is cleaned  with saline, the dead tissue is removed, the wound is covered with flammazine and paraffin gauze.

After dismissal from hospital the wound improved, but deteriorated the past few days with new breakouts to surrounding areas.
What should we do?

[Bhupinder Kaur, MD]

Hello,
For such kind of ulcers, it is better to consult a general surgeon. First of all the surgeon will feel the depth of the wound with his hands and then the area will be cleaned with normal saline.Then with the help of a scalpel, scissors, or other instrument dead tissue is cut from the wound. All this is done under local anaesthesia. It is the quickest and most efficient method of debridement.
After debridement,dressings are applied which are to be changed periodically. Superficial opened wound can heal by secondary intention phenomenon,but if wound is a deep one,then suturing of the wound is done.This is done only when healthy pink granulation tissue is seen after debridement and regular dressings.

Superficial wounds that do not require stitches heal in a short time. Since wound healing has been delayed in your mother’s case, so please get it evaluated. Delayed wound healing can occur in vitamin C and vit K deficiency,diabetes,p-rotein deficiency,immunocompromised states and if the person is taking corticosteroids or immunosuppressants.

It is very difficult to precisely confirm a diagnosis without examination and investigations and the answer is based on the medical information provided. For exact diagnosis, you are requested to consult your doctor. I sincerely hope that helps. Take care and please do keep me posted on how you are doing.