Gangrene Wound Closing Case Report

Gangrene Wound Closing Case Report

Gangrene Wound Closing Case Report: This report was written in 2013. For some needs, I post it now on Aug 19, 2016. Below is the original article. Below is the original case report wrote in 2013. For the treatment results, please click and read A Gangrene Case.

Abstract

It’s initially a dry gangrene case caused by streptococcus agalactine (GBS) and proteus mirabilis infection and got left heel erosion.  There were western treatment, Chinese medicine treatment and aided with growth factor as the main role to help wound closing. The prognoses can be seen from the attached pictures (attachment 1).

The slower growing part near by the posterior heel is under the circulation supply of the posterior of the leg. It’s the part that did not get acupuncture treatment to loosen the muscles/tendons. If the case’s full prognosis can be treated under medical professionals especially under Chinese medicine’s treatment for the recovery period, it might get quicker result.

The cause and the initial treatments followed traditional western medicine treatment. Then, Chinese medicine involved to treat antibiotic side effect of anorexia, clear the digestion tract and help circulation – the key of recovery and healthy. The Well Med growth factor plays main role to help wound close. All of the combined treatments make the good results and hope can do clinical trial to avoid amputations in the future.

Introduction

It is an eyes catching case that there is possibility for gangrene patients avoiding amputation and recover quicker in lower cost home care setting by using Well Med growth factor daily serum.

In 2006, my decades diabetic type II father got notice to cut off his left leg below his knee due to a gangrene wound on his dorsal side of left foot. I went back and used acupuncture with moxibustion to treat him and another local herbalist used herb to treat due to the herbalists has all kind needed herbs. My father’s left leg was saved.

In a evening class on Jan 2, 2013, when my classmate told me that her mother’s left heel got erosion and could see her bone. And they already changed a couple doctors. The next morning, I visited her home to help avoid amputation.

Description

Patient is a 89 years old lady with no medical history except for recent half year due to left heel pain gradually lost her mobility and lays down on bed whole day long.

The story was started with the patient’s 3rd child-her caregiver when cleaned her and changed her, by raising her left foot, discovered that there was a soft spot and looks like some liquids inside. A nurse used a needle broken it and squeezed out some sticky body fluid. Later, when the skin fell down, the inner side was black and from its edges came out some liquid and when the black spot dried, it fell down became what we see on the beginning picture on the attachment 1. Then, they started to visit doctors and kept changing doctors for recovery solutions. It was around 2012 Thanksgiving.

Two weeks before 2012 Christmas, my classmate asked me that what can caused a black spot in her mother’s heel.

The gangrene was caused by streptococcus agalactine and proteus mirabilis infection as attachment 3.  The other test on Dec 14 2012 was as attachment 4, 5 and 6 for blood test.

On Jan 3 2013, I gave acupuncture/moxibution with external used herbs treatment  to loosen patient’s both lower legs’ anterior and lateral muscle/tendons to clear her digestion tract path way and increase both legs’ circulation as well as to treat her anorexia. Aided with an external Chinese medicine to help disinfection and reduce wound on left heel.  Due to it’s too far for me to do home visit, I taught the daughters how to apply moxa on the wounded area and on the other places that can help open up appetite and improve patient’s health as well as increase leg’s circulation. I told them that good circulation is critical for patient’s recovery. In the afternoon, I recommended to apply growth factor on the wound area.

The third day, I did follow up call. Patient’s care giver told me that her mom yesterday had more stool came out, some with dark color and her mom could eat better.

Later, the follow up calls told me excited news of wound closing. The whole progression is as attachment 1 pictures.

There is a nurse coming in once every day to help clean the wound and watch care giver to put the topical medicine(s). Twice a day – morning and afternoon, the procedure is:

  1. Take off the wound cover.
  2. Soak wound in Pedi-boro Soak (Attachment 7) Solution -prescribed by dermatologist Sumala Lo, M.D. It’s suppose 1/4 pack with 1 small bowel around 200 ml. But care giver uses1/3 pack with 200 ml water. It makes the wound without infection.
  3. Apply topical medicines – applied Kendall Thermazene  (Silver Sulfadiazine) Cream 1% (attachment 8) daily on the wound area.
    a. Before Jan 3, applied aloe Vera Past on gauze.
    b. From Jan 3 about a week, applied the herbal powder (I bought from outside source for wound recovery use) that I left to put on the aloe vera past and growth factor of Well Med daily Serum on guza. After the herbal powder gone, only the daily serum is put on the wound area.
  4. Put the guza on wound area. Do moxibution to help penetration. However, moxibution treatment was on and off.
  5. After the herbal power was gone, this item was took off.
  6. Until start to see wound closed quicker around Jan 20, the aloe vera past also stop used.
  7. After Jan 26, a bottle of Well Med recovery serum was applied for a couple of days. But, it did not speed up the recovery.

As the caregiver said that the wound was on the speed of 1 mm/day smaller in diameter before Feb 14, 2013.

In order to help circulation, my friend put FIR ring on patient’s ankle, knee pad either on knee or lower left leg, FIR/negative iron emitter pad put under left heel  plus 24 hours under magic lamp (electromagnetic) therapy on her left lower leg and heel to avoid ischemia.

Daily, there are more than 30 kinds supplements were used. Some of them are gifts or trial taking without purchasing new one. The attachment 9 are the most used supplements.  It costs more than $1,000/month to buy those supplements. Diet mainly is juice of carrot, apple, potato sometimes with other fruits.

The other prescriptions used are Sadium Chloride 0.9%, Levofloxacin and Amoxicillin/clavulan as attachment 10~16.

The patient lays on the bed even no strength to raise her own arm. Her daughter helps her turning her body every hour and takes care her urination (several times day and night) and bowel movement (once a day) without any bed sore.

Patient’s face is oily and shinny. However, her pulse is always very strong. Jan 3 2013 visit was fast and root is very deep nearby bone but fine and weak. After treatment, it goes normal speed without the forceful pulse but deep, weak and fine. Mar 15’s pulse was forceful and root is weaker than before except left kidney position.

Discussion:
Anaerobic and gangrene treatment in lower limbs, amputation and related problems:

  1. Anaerobic culture is 5 time cost of aerobic culture12. Antibiotic resistance is another treatments and guideline issue7. Antibiotics induce neurotoxicity and encephalopathy9  is a major concern for avoiding antibiotics. Even I had a patient after antibiotic IV almost dying. I used acupuncture/moxa saved her and other antibiotic neurotoxin patient.
  2. Chronic wound can cause gangrene and over 28% death in two years3,8.
  3. Foot problems induced by neuropathy, ischemia, infection caused lower limbs amputation (LLA) as well as 42% 3rd year LLA and 56% 5th year LLA4.
  4. LLA can caused by the diabetic 60.7% and 46.2% died during first year post-admission, trauma (2/3 extremities, 1/3 abdominal wall6), end stage renal diseases1, etc.
  5. Vascular reconstruction5,10  can reduce amputation. However, there are blood and training problems for patients’ psychological concerns11,13.
  6. Look at #3, 4 that the medical efforts are a loss. It means the root problems of physical and emotional did not take out.
  7. Traditional Chinese Medicine (TCM) treat foot problems and gangrene eliminate the physical root problems15.

GF:

  1. GFs help to grow fibroblasts, vascular endothelia cells16, vascular smooth muscles16, keratinocytes16, bones18, nerve17, tendon20 in cases of defect skin, soft tissues by trauma16, burns16, pressure sore16, gangrene16, hypochondroplasia18, tinnitus/sound-perceiving nerve deafness17, diabetes16,  collagen diseases16 and stroke19.
  2. There are different growth factors of bFGF16, NGF17, IGF-118, aFGF19, FGF221, VEGF20, TGF-β120 etc. can they be simplified to be one kind for all functions?
  3. There are contraindications for GF such as addiction21, cancer23 . Is there any other contraindication?

This case:

  1. We can know that patient’s family member do what they can do to help themselves. We can notice the trend that patients prefer to spend money to buy products instead of paying medical professionals especially paying money out off their own pocket. By doing so, many sickness can be delayed for treatment. Therefore, public education is needed.
  1. For the gangrene treatment, good circulation is the key. If can loosen patient’s left posterior lower leg, it might help wound close quicker.
  2. If we can bring TCM and growth factor treatment for gangrene patients will be a good news to avoid amputation that is not only costly but also a big physical and psychological hurt for patients plus possible mobility loss and more healthcare cost is needed.However, more clinical trials should be made in order to set up a healthcare protocol.

Summary
This gangrene case of streptococcus agalactine and proteus mirabilis infection is well treated by non-systematic regulated western and Chinese medicine plus Well Med growth factor daily serum.

Conclusion

The effectiveness of TCM treat gangrene needs to be widely reported.

Clinical trial to use Chinese Medicine and growth factor to treat gangrene will be a worth try due to avoid antibiotic caused environmental damage, bacteria mutation, treatment guideline changes, cost of anaerobic culture as well as problems and cost involved in vascular reconstruction surgery.

Avoid amputation or do minimum amputation is a challenge for patient’s education about poor circulation and wound injury could cause potential amputation problems.

Looking for professional treatments is also needed as early as possible such as this case’s heal pain if looking for professional help in the early stage will not let patient lost her mobility, life quality with a 24 hours caregiver’s life be tied with the patient.

Though the case is successfully well treated, it leaves a lot discussion about the future researches for growth factors, gangrene treatments and public education.

 

References:

Anaerobic Infections, antibiotics  & Amputations

  1. Eggers PW, Gohdes D , Pugh J,  Nontraumatic lower extremity amputations in the Medicare end-stage renal disease population.  Kidney International [Kidney Int] 1999 Oct; Vol. 56 (4), pp. 1524-33.
  2. O’Rourke I, Heard S , Treacy J , et al, Risks to feet in the top end: outcomes of diabetic foot complications. ANZ Journal Of Surgery [ANZ J Surg] 2002 Apr; Vol. 72 (4), pp. 282-6
  3. Behrouz Dadkhah, Sousan Valizadeh,  Eissa Mohammadi,  et al,  Psychosocial adjustment to lowerlimb amputation: A review article. HealthMed. 2013, Vol. 7 Issue 2, p502-507
  4. Senra, Hugo, Oliveira, Rui Aragão. et al, Beyond the body image: a qualitative study on how adults experience lower limb amputation. Clinical Rehabilitation. Feb2012, Vol. 26 Issue 2, p180-191
  5. Ismailov NB, Vesnin AV, Lower limb distal atherosclerotic gangrene–is high amputation always necessary? Khirurgiia [Khirurgiia (Mosk)] 2008 (9), pp. 51-5.
  6. Gangrene Gale Encyclopedia of Medicine. medical-dictionary.thefreedictionary.com Copyright 2008 The Gale Group, Inc.
  7. Elisabeth Nagy, Anaerobic Infections: Update onTreatment   Drugs (ADIS International Limited). 2010, Vol. 70 Issue 7, p841-858. 18p. 3 Charts.
  8. Escandon J, Vivas AC , et al, [High mortality in patients with chronic wounds. Gangrene/amputation ]  The Wound Healing Society [And] The European Tissue Repair Society [Wound Repair Regeneration] 2011 Jul-Aug; Vol. 19 (4), pp. 526-8.
  9. Grill, Marie F Grill, Rama K Maganti, Neurotoxiceffects associated with antibiotic use: management considerations. British Journal of Clinical Pharmacology. Sep2011, Vol. 72 Issue 3, p381-393
  1. Tsarev, O. A. Prokin, F. G. Zakharov, N. N.,3 et al, AMPUTATION OF EXTREMITY IN PATIENTS WITH ATHEROSCLEROTIC  Saratov Journal of Medical Scientific Research / Saratovskii Nauchno-Meditsinskii Zhurnal. Oct-Dec2011, Vol. 7 Issue 4, p947-953.
  2. Senra, Hugo, Oliveira, Rui Aragão. et al, Beyond the body image: a qualitative study on how adults experience lower limb amputation. Clinical Rehabilitation. Feb2012, Vol. 26 Issue 2, p180-191
  3. Bharadwaj, R, Anaerobic microbiology: Time to rejuvenate.  Indian Journal of Medical Microbiology  Jan2012, Vol. 30 Issue 1, p3-5.
  4. Behrouz Dadkhah, Sousan Valizadeh,  Eissa Mohammadi,  et al,  Psychosocial adjustment to lowerlimb amputation: A review article. HealthMed. 2013, Vol. 7 Issue 2, p502-507
  5. Hershkovitz, Avital Dudkiewicz, Israel Bill, et al, Rehabilitation outcome of post-acute lower limb geriatric amputees. Disability & Rehabilitation. 2013, Vol. 35 Issue 3, p221-227
  6. Chinese and Western Mudicine Competition – vasculitis and gangrene treatment process. http://goo.gl/zIY1V

Growth Factors

  1. Aluminum foiltreatment combined with basic fibroblast growth factor (bFGF) for gangrene of the fingertip caused by collagen disease. Scandinavian Journal of Plastic & Reconstructive Surgery & Hand Surgery. Nov2005, Vol. 39 Issue 5, p312-314.
  2. ZHOU Feng, WU Ping, WANG Li, et al, The NGF Point-Injection for Treatment of Sound-Perceiving Nerve Deafness and Tinnitus in 68 Cases.  Academy Of Traditional Chinese Medicine [J Tradit Chin Med], ISSN: 0255-2922, 2009 Mar; Vol. 29 (1), pp. 39-42
  3. Rothenbuhler A, Linglart A, Piquard C, et al, A pilot study of discontinuous, insulin-like growth factor 1-dosing growth hormone treatment in young children with FGFR3 N540K-mutated hypochondroplasia. The Journal Of Pediatrics [J Pediatr] 2012 May; Vol. 160 (5), pp. 849-53. Date of Electronic Publication: 2011 Dec 02
  4. . Cheng X; Wang Z, et al  Acidic fibroblast growth factor delivered intranasally induces neurogenesis and angiogenesis in rats after ischemic stroke.  Neurological Research [Neurol Res] 2011 Sep; Vol. 33 (7), pp. 675-80
  5. Heisterbach PE , Todorov A, Flückiger R, et al,Effect of BMP-12, TGF-β1 and autologous conditioned serum on growth factor expression in Achilles tendon healing. Knee Surgery, Sports Traumatology, Arthroscopy: Official Journal Of The ESSKA [Knee Surg Sports Traumatol Arthrosc] 2012 Oct; Vol. 20 (10), pp. 1907-14
  6. Clinton SM ; Turner CA ; Flagel SB, et al, Neonatal fibroblast growth factor treatment enhances cocaine sensitization. Pharmacology, Biochemistry, And Behavior [Pharmacol Biochem Behav] 2012 Nov; Vol. 103 (1), pp. 6-17
  7. Lou Z, Healing large traumatic eardrum perforations in humans using fibroblast growth factor applied directly or via gelfoam. Otology & Neurotology: Official Publication Of The American Otological Society, American Neurotology Society [And] European Academy Of Otology And Neurotology [Otol Neurotol] 2012 Dec; Vol. 33 (9), pp. 1553-7
  8. Dieci MV, Arnedos M , Andre F, et al, Fibroblast growth factor receptor inhibitors as a cancer treatment: from a biologic rationale to medical perspectives. Cancer Discovery [Cancer Discov] 2013 Mar; Vol. 3 (3), pp. 264-79. Date of Electronic Publication: 2013 Feb 15

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