Case Profile: Thrombophlebitis with Dermal Ulcers

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

Diagnosis: Thrombophlebitis (Left Lower Extremity) with Multiple Dermal Ulcers (Both Lower Extremities) History

  • Approximately 12 weeks prior to presentation at Meditech Laser Rehabilitation Centre, the patient was admitted to hospital with a presumptive diagnosis of necrotizing fasciitis
  • Multiple biopsies were carried out and cultures had revealed the presence of Staphylococcus aureus-G
  • Hospitalized approximately twelve weeks*
  • No improvement of ulcers despite intensive therapy in the hospital, including:
  • – oral and intravenous antibiotics
  • – daily dressing changes
  • – hyperbaric chamber
  • – analgesics
  • – daily dressings

Physical Examination on Presentation at Meditech Clinic

  • Severe dermal breakdown and lesions
  • Circumference of right mid-calf 6cm greater than the left
  • Both legs were painful, the right being most severely affected

Treatment at Meditech Rehabilitation Clinic

  • All wounds left open
  • Elimination of all medications except analgesics p.r.n.
  • Saline compresses periodically
  • Laser therapy

Figures

  • Fig. I to III – Prior to initiating therapy
  • Fig. IV to V – After 8 treatments
  • Fig. VI – After 23 treatments

Outcome After 23 Treatments:

  • All ulcers healed
  • Diameter mid-calf equal bilaterally

* patient discharged himself against medical advice


** It should be noted that this patient was not highly compliant, however despite this, he responded well to laser therapy. Lack of compliance is sometimes a byproduct of the psychological change in people with severe chronic problems.




thrombophlebitis

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