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Final Program


Final Program

829 - Foot burn complication in a diabetic patient

Friday, February 28, 2025
5:00 PM - 6:30 PM MST
Case Diagnosis: Diabetic patients with peripheral neuropathy may sustain foot burns that can be managed conservatively with bed rest and regular wound dressings. However, eschar excision and skin grafting, may be necessary with extended hospital stays which increases the risk of nosocomial infections.

Case Description: A 56-year-old man with poorly controlled type 2 diabetes mellitus for 10 years at the stage of degenerative complications, treated with insulin. He had history of 3rd degree burns on both feet. He received 1 month of antibiotics and multiple excision with no follow-ups, about 7 weeks before being admitted in our unit.
At his initial exam, he had loss of tissue in feet and ankles, with exposed tendons, areas of necrosis and fibrin.
He received local care, regular dressing changes, repeated excisions, and the implementation of vaccum assisted closure (VAC) therapy. The patient refused cefazoline and took 3 days leave of absence When returned, the condition of his feet deteriorated, with pus discharge, abscesses, necrosis of the calcaneus. 

He underwent bilateral mid-leg amputation. He was discharged after 5 months.




Discussions:

Foot problems are common in diabetic patients. Two separate studies have estimated that 15 to 25% of people with diabetes mellitus will experience foot problems during their lifetime. 

Unfortunately, these patients often seek medical attention late, frequently with severely deteriorated lesions. Zachary and colleagues demonstrated that immediate in-hospital treatment reduces complications. Patients with delayed hospital admission experienced more cellulitis and hypertrophic scarring, had prolonged hospital stays, and required more grafting. Neuropathy, combined with poor vascular supply and edema, results in impaired wound healing. Eventually, wound infection, gangrene that can lead to amputation .
Our case confirms this, as a multidisciplinary approach was delayed by 7 weeks with extensive consultations from various doctors.

Conclusions:

Special educational efforts should focus on individuals suffering from diabetes experiencing sensory loss in their lower extremities.