Abbreviated case report using type I collagen1
The patient was referred to as an alternative to amputation by his primary care physician. His ankle brachial index (ABI) was reported as 0.41 with toe pressures of 60 mm/Hg. Initial care consisted of avulsion of his second toenail, debridement of necrotic tissue, and curettage of osteomyelitic bone with bone specimen for tissue culture report.
He had a polymicrobial infection. The patient’s treatment was changed to collagen impregnated with clindamycin on the fourth day. The wound had completely resolved in approximately 90 days.
The patient had been treated at a local diabetes treatment center without success. The recommendation from the orthopedic specialist was to admit the patient to the hospital for intravenous antibiotics and to schedule him for amputation. Home health nurses had been asked to change from gentamicin to clindamycin imbedded in collagen 48 hours prior to this visit, at which time necrotic tissue was debrided.
On day 13, minimal necrotic tissue was noted. The perimeter of the wound showed the presence of a good granular bed. Collagen lattice was present in the mid-central portion of wound bed.
On day 18, the digit showed minimal edema and erythema. There was still a dusky appearance to the toe, but the wound continued to show improvement in size, shape, and appearance. Granular tissue continued to develop, and margins were getting narrower. Keratin appeared at the perimeter of the wound, which had become smaller.
After debridement, the wound bed was virtually 100% granulated, and the wound continued to get smaller and shallower. Erythema was minimal and no local edema was visible.
On day 53, the toe showed no erythema, edema, undermining, or tunneling, and the wound continued to shrink. By day 74, the wound had epithelialized. The digit showed complete resolution of the infectious process.
At a follow-up visit 10 weeks later, the wound site was 100% epithelialized. The toe showed minimal scarification, and the skin was soft, supple, and pliable. After one year, the digit was pink, clean, clear and closed without any signs or symptoms or other sequela of potential breakdown present.
Reference
1. Kollenberg L. A new topical antibiotic delivery system. World Wide Wounds (electronic wound journal). 1998. Surgical Materials Testing Laboratories, Bridgend, Wales, UK. http://www.smtl.co.uk/World-Wide-Wounds/.
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