The patient is a, otherwise healthy 84 yo woman who had a squamous cell carcinoma of the left pretrial area in 2018 that was treated with radiation. The area took 18 - 24 months to heal after XRT. Due to concerns about a new crusted area at the site, it was biopsied in April 2023; but has not healed since then. In August 2023, there was a 6 mm in diameter ulcer. In July of 2024, she had moved to another state and a wound care physician re-biopsied the area and curretted it, In the ensuing three months the ulcer has grown to its present size of 3.7 x 2.7 cm and is constantly painful. (Both biopsies showed no evidence of cancer.)
She has good pedal and dorsals pulses and has had arterial and venous studies of her leg show normal findings. Ankle Brachial and Toe Brachial Indexes are normal.Wound cultures have repeatedly grown out a mixture of Pseudomonas, Coagulase Negative Staph and Strep species.
12.12.23
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1.27.24
What is your diagnosis and what do you think is the best way to care for this ulcer?
