Healing a Complex Wound

Patient overview

93 year old female; patient initially presented with three wounds. Pictured below is the right heel wound and the most severe of the three wounds.

diabetic foot ulcer treatment - wound management

Serial Sharp Debridement, Cellular Tissue Based Product, Hydrophilic Wound Paste

Time to heal

12 weeks

case presentation

Patient is a 93 year old female that initially presented with three wounds. The above pictured wound was the most severe of the three wounds. Treatment of this patient began 1/12/22. During the course of treatment, the patient developed three other wounds to her feet. Two were the result of deep tissue injury, and one the result of a skin tear. All six wounds were to the feet.

The wound locations are as follows: Right heel, right dorsal surface, right lateral tuberosity, left lateral heel, left dorsal surface, left lateral tuberosity.

With the development of the three additional wounds and the development of the right dorsal surface wound, a clinical decision to culture the wounds and order arterial dopplers was made. The culture returned positive for MRSA, Enterococcus faecalis, and Bacteroides fragilis. Doppler results indicated atherosclerosis with worsening towards the feet. The course of treatment was adjusted to include antibiotics, less compression, and dual wound care therapies. There is no doubt that hospitalization was prevented for this patient, and possible limb loss as well.

assessment and management

  • Specific modalities of wound care involve weekly debridement of slough in all six wounds.
  • Dorsal wounds responded poorly to cellular tissue products (CTP) secondary to poor circulation.
  • Bilateral heel wounds responded optimally to CTP placement as indicated in the photos above.
  • At the most recent visit, CTP was discontinued on all but the left lateral heel in favor of a hydrophilic wound paste.
  • Facility staff augment care provided by changing dressings every other day and reapplying the hydrophilic wound paste.


The patient is nearing wound closure of four out of six wounds.