TS's Patient Story
Saving a Gangrenous Toe From Amputation
TS, a retired pilot with Type II diabetes, requested an appointment with Dr. Brem's wound healing program after being treated unsuccessfully for a toe ulcer at another institution, where he was told that he needed a limb amputation. After he’d contacted us, however, the toe began turning gangrenous, so rather than wait for the scheduled appointment—by which time the ulcer most likely would have been beyond the point where it could be treated effectively—arrangements were made to admit him immediately as an inpatient. In the first hours after his arrival, he was examined by a wound physician, a cardiologist, a vascular surgeon, and nephrologists.
After hydration and cardiac optimization, he was brought to the operating room. (The majority of our patients are operated on using just local anesthesia and sedation.) There, he underwent a debridement procedure, at which time collagen and GM-CSF were applied to his wound. The next day, a vascular surgeon performed an arterial bypass in his lower leg, where a blockage had been found. Two days later, a second debridement was performed during which cellular therapy was administered in addition to collagen and GM-CSF. The patient was also given an intravenous broad-spectrum antibiotic to combat his infection, which had spread to the bone.
Following the second procedure, the patient was in significantly less pain and was no longer at risk for amputation. He continued to receive treatment as an outpatient, including IV antibiotics. During this time he was monitored closely and additional debridement, hyperbaric oxygen and cell therapy procedures were performed on his wound, culminating in a skin graft. Several weeks after his wound closed, he was playing tennis again.