wound care, biopsy?

have a concern about a non-healing wound that my mother has.   She is 75 yrs. old, very active, and in good health.  Five months ago she cut her leg shaving and it has yet to heal.  She never told me until 2 months after the cut because she was in a lot of pain.  I took her right to the dr. and we were sent to a wound specialist.  They did a culture and got her on antibiotics.  She has been going there for treatment every week for 3 months and it's not healed.  She has terrible pain and can't sleep most nights.  Even the sheets hitting her leg is too much to take.  She was negative for diabetes and she had vascular tests done that were all normal.  The doctor now wants her to have a biopsy done.  Are they thinking skin cancer?  Even from a little cut from a razor?  She' never been a sun worshipper.
I'm worried.
Thank you for any information.

[caregiver222]

Your mother requires evaluation by a wound-care specialist, commonly associated with diabetic clinics. As soon as possible. As of yesterday. Leg wounds that won't heal are common in diabetics (as well as the elderly with compromised micro-circulation)  and require a lot of professional attention. The avergae GP is above his pay grade in treating these.

There are various approaches, the most recent and (non-approved) is the use of a nicotine patch or smoking a cigarette or two a day. The American Indians used to treat arrow wounds with a poultice of tobacco. It turns out nicotine enhances wound healing. Nature magazine (about two years ago) announced a study to establish the value of either a tobacco poultice or a nicotine patch to treat wounds that would not heal. Do a search on their database.

While it is indeed possible there is a malignancy, the probability is your mother has an encapsulated bacterial infection in an area that receives little circulation.

To enhance micro circulation supplements of alpha-lipoic acid and omega-3 fish oils (1000mg a day) will be helpful.

Such wounds can also be treated by phage poultices, however this treatment is only available in the Republic of Georgia and some parts of Russia. It works very well with wounds such as you describe.  It was a standard treatment for infections in the former Soviet Army. Soldiers were supplied with "phage packets" rather than anti-biotics. One of the pioneers in phage therapy was one of the two people who recieved the Nobel Prize for DNA, Watson and Crick. I met Watson once and had an extensive discussion with him as to why phages were not used in wound treatments for diabetics.

Oral anti-biotics usually don't work, and one ends up going the intraveous route, and even then success is not guaranteed. Gamma globulin is very expensive, but is often used to promote healing.

Dressing protocol is controversial, and the wound care people are the best people to consult in your area.

Debriding and treatment with ultra-violet light was used seventy years ago on such infections. A nobel prize was awarded in 1904 for establishing this protocol.

Hyperbaric oxygen is another treatment. The patient is placed in a large chamber and oxygen at above atmospheric pressure is introduced. This is especially effective with anaerobic bacteria infections. Check and see if a facility for such treatment is available in your area. Your mother can be transported back and forth to the hyperbaric chamber. This treatment is often the difference between the loss of a leg or life.

[Dr. Kokil Mathur]

Hi
Thanks for writing to the forum!
Generally such wounds/scabs/ulcers that do not heal are due to underlying infection, low supply of oxygen to the wound that is reducing the healing process, underlying diabetes, or due to dermatitis. Any irritation to the skin can be a potential source for cancer. Hence there is no harm in getting a biopsy. In fact non-healing ulcers are often due to cancer.
Wounds heal slower in diabetics or smokers or alcoholics who have been smoking and drinking for a long time. So these have to be ruled out.
Hope this helps. Please let me know if there is any thing else and do keep me posted. Take care!