Wound Care Protocol

Patient presented with an unhealed wound of the right posterior ankle sustained while traveling abroad, when her foot was caught in the chain of a moped. She received initial medical attention overseas, though the treatment given is unknown. On returning to the U.S. roughly ten days later, she sought care from her PCP and was treated with doxycycline 100 mg BID for 10 days plus home health dressing changes three times weekly — wound cleansed with normal saline, mupirocin 2% applied, covered with gauze and ACE wrap.

Despite completing the full course, the wound remained unhealed and developed yellowish drainage. The PCP prescribed an additional four days of doxycycline 50 mg BID, but the patient stopped with two days remaining due to body aches, joint pain, and headaches.

Patient with spinal cord infarction and resulting neurological deficit, chronic Foley catheter use, and two chronic ulcers. Following a syncopal episode, he was hospitalized and diagnosed with the spinal cord infarction; during the first month of that admission he developed a sacral pressure ulcer from prolonged immobility that failed to heal. He was transferred to a transitional care facility for a month, then began weekly wound-clinic visits with home health wound care 3–5 times per week.

The sacral site healed and re-opened multiple times. Roughly ten months after the initial event he was re-hospitalized for malnutrition and significant weight loss; during that admission, prolonged positioning on his right hip produced a new, larger ulceration over the area.

Diabetic patient presented for evaluation of a left foot wound. The course began when the left first toe abruptly developed swelling and erythema; he went to the ER, received antibiotics, and was referred to podiatry. Despite regular podiatric care the toe worsened, requiring amputation of the left first toe about two months later. Postoperatively the second toe darkened and ulcerated, worsening until it too required amputation roughly five months after the first.

He continued with podiatry and vascular surgery for diabetic PAD, undergoing two angiograms with vascular interventions — both of which eventually failed. Within a year of onset, the remaining left toes required amputation due to progression to cellulitis, purulent wounds, gangrene, and osteomyelitis. The distal left foot did not improve despite IV antibiotics.

Insulin-dependent diabetic followed in wound care for over a decade for severe bilateral lower-leg swelling with recurrent lymphedematous eruptions. He routinely uses a tactile lymphedema pump; when compression wraps loosen he removes them and substitutes Velcro compression garments layered with lymphedema compression wraps. He underwent sclerotherapy on each leg several years into his course.

Body habitus makes leg elevation and exercise very difficult, and morbid obesity significantly contributes to the lymphedema. He is prescribed Lasix twice daily but reports taking only one tablet per day because the increased urinary frequency makes it hard to reach the restroom in time.

Patient with diabetes mellitus, three prior lumbar laminectomies, and chronic Foley catheter use presented with a lower back/sacral wound present for approximately four months and gradually worsening.

She additionally reported a new maculopapular, blanching rash over the entire left arm noticed over the prior two weeks — itchy, non-painful, without drainage, and warm to touch. No new medications or exposures were initially reported. No history of tobacco use.