Diabetic Patient with Infected Wet Gangrene after Amputation

An 87 year old female with Diabetes mellitus type 2 (DM2), suffered from an open wound on her left foot due to a transmetatarsal amputation. The DM2 was diagnosed in 1986 and she uses metmorfin 500mg to control the DM2. She also has hypertension for which she uses amlodipine and valsartan once a day.

The patient was treated as an outpatient at first with dry dressings and hyperbaric oxygen. This seemed effective, however, wound healing was slow and culture swabs showed that the wound was infected with proteus mirabilis. Proteus mirabilis is a very commonly recovered organism, especially from urinary and wound infections.

The wound showed little to no progress. After 10 days, the physician decided to change therapy to a honey based approach. L-Mesitran Ointment was applied daily and covered with a regular absorbing dressing. After 4 weeks, a collagen graft was done. Thereafter, freeze dried collagen product was used.

At first review, the wound measured 5.1×8.5×2.2cm and showed necrotic and sloughy tissue. After 9 days in the treatment, the wound was debrided for more than 50% and the bacterial infection had subsided.

Four weeks in the treatment, the wound debrided fully and the collagen graft was applied. The ointment was used regularly in addition.Four months after the start of the treatment, the wound was closed by 2/3. The wound progressed to full healing without adverse events.

During the 6 months follow up, the wound was closed. The debriding qualities and antibacterial efficacy were well demonstrated by the honey ointment; it prevented further amputation. The open left foot wound healed completely, without adverse effects in 6 months time.