Vilayvanh Saysoukha, DPM, MS, FASPS, FACPM, AACFAS
I received a consult for an 84-year-old male with worsening appearance and malodor of a full-thickness ulcer on his right medial foot. The patient had dementia and had been at the hospital’s behavioral unit for several weeks. The patient and hospital staff could not give any history about the wound, such as the chronicity, or any previous treatment. Surprisingly, his lab work was unremarkable. He did have positive methicillin-sensitive Staphylococcus aureus (MSSA) blood cultures, most likely from the foot wound. A magnetic resonance imaging (MRI) study was contraindicated due to metal present from a hip replacement. Computed tomography (CT) with and without contrast did not show any bone involvement, subcutaneous emphysema or abscess. For infection source control, I planned to excise the entire ulcer plus some normal skin margins and send it to pathology. I contacted the patient’s daughter to obtain more history of the wound … read more