Angioplasty and delayed healing until removal of sequestrum in a neuroischaemic foot

A 91-year-old lady with type 2 diabetes of 20 years' duration who lived in a nursing home was referred as an emergency with a painful oedematous, ischaemic left foot complicated by severe cellulitis and lymphangitis and a malodorous ulcer on the apex of her 2nd toe. A swab grew mixed coliforms. The 5th toe had a bluish tinge. Her Doppler waveforms were severely damped and her pressure index was 0.3. She was admitted for wide-spectrum intravenous antibiotics and underwent angioplasty of the superficial femoral artery and anterior tibial artery. Within 3 days of the procedure the pain had greatly diminished, but the blue area of the toe was necrotic. She was followed up in the diabetic foot clinic and was given extra-depth shoes and regular debridement every 2 weeks. After 5 months an area of loose bone was evident in the wound. The bone came away to reveal complete healing of the wound after 10 months.

Key points

• Advanced age is not a contraindication to vascular intervention

• Angioplasty can be routinely and safely carried out in elderly patients who might not be fit for vascular surgery

• Improved pain is a good mark of clinical progress

• Bony sequestrum in a wound delays healing and should be removed.

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