Submitted by Christopher L. Barrett, DPM, CWS, FAPWCA

Patient is a 90-year-old female with a non-contributory PMH who initially presented to the outpatient wound department with a trauma-induced right anterior leg wound in January of 2017. Non-invasive arterial testing demonstrated and right ABI of 1.07, a TBI of .48 and mild dampening of the pulse volume tracings. The wound required six months of compression and local care, including cellular and/or tissue-based products (CTP) to heal. The patient returned two months after initial discharge complaining that the wound appeared healed but was still painful and somewhat pruritic. Venous reflux study was negative and she was referred to her PCP for follow-up. The patient again returned to the outpatient wound department in August of 2020 after suffering mild trauma to the same location as the previously healed wound. After four months of care the wound appeared healed only to have the patient return one month later in January of 2021 stating the wound had gradually reappeared.

A. Compression therapy
B. Repeat non-invasive arterial studies
C. Wound biopsy
D. Debridement and CTP application(s)

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