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.