Case Profile: Dermal Ulcer Traumatic Origin

Author: Fred Kahn MD, FRCS (C)
Source: Meditech International Inc.

Original Diagnosis

Extensive contusion injury right anterior tibia

63-year-old retired school teacher fell down a flight stairs on August 03, 2006 and subsequently developed an extensive hematoma and wound on the anterior aspect of the right tibia. Draining sinus and ulcer developed and packing of the deep tissues/dressings was applied every two days. Patient was treated with an extensive number of antibiotics and other medications without any significant improvement.

Physical Examination

  • right calf 1.5inches greater in diameter than left
  • draining sinus and ulcer present
  • marked tenderness and edema anterior tibia

Therapy at Meditech Centre

Initiated October 04, 2006:

  • all medications discontinued
  • dressing discarded and wound treated by open exposure
  • saline compresses applied during night
  • laser treatment utilized every second day

# of Treatments

  • fourteen over a course of three weeks.

Final Result

  • patient asymptomatic
  • no evidence of inflammation
  • ambulating without difficulty
  • mid-calf diameter equal bilaterally
  • healing of ulcer and sinus

Condition on Discharge

  • ulcer healed
  • no medication or additional therapy required
  • patient fully functional
dermal1
Figure 1. Picture of anterior tibia (10 days post-trauma).

(August 19, 2006)
dermal2
Figure 2. Initiation of laser treatment.

(October 4, 2006)
dermal3
Figure 3. Intermediate stage.

(October 10, 2006)
dermal4
Figure 4. Picture October 24, 2006, at discharge.

(October 24, 2006)
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