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case 1 chronic ulcer left leg

female patient 38 years old

underlying thyrotoxicosis

occupation : female shopkeeper

patient history : lesion started from insect bite then became pustule and pus collected

6 week PTA , she went to hospital for incision and drainage wound ,

the doctor gave Dicloxacillin 1 tab qid for a week

she dressing wound herself at home

the wound became larger then she came to hospital

physical examination : solitary non-healing ulcer size approximately 2.5 cm. with purplish surrounding skin mild tender when pressing   at  lateral side of left leg 

both leg has discrete post inflammatory hyperpigmentation from insect bite reaction

diagnosis : Non-healing ulcer 

treatment : Augmentin 1 g 1 tab bid for a week 

dressing and debridement

follow up : 1 week if not improve plan biopsy 

problem  non healing ulcer 

cause of non healing ulcer

  1. vascular disease

  2. venous insufficiency , arterial insufficiency

  3. diabetic especially poor controlled , smoking

  4. skin cancer such as basal cell carcinoma or squamous cell carcinoma

  5. infection

  6. leprosy sensation lost , ulcer from injury

  7. melioidosis , non healing skin abscess and ulcer

  8. non-tuberculosis mycobacterial  , started lesion like insect bite

  9. other infection , nocardia , actinic mycosis , chromoblastomycosis

  10. straph MRSA infection

  11. Foreign body

click to read more about wound healing 

Follow up 1 week 


Wound improve plan stop antibiotic continue dressing

Pt buy duoderm used by herself click for more about duoderm hydrogel 

Follow up 2 week

three week follow up after dressing for weekly for 1 week

the ulcer shallower

no sign of active infection


plan dressing at SX department then follow up 1 month

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