I have been treating a chronic diabetic leg ulcer with negative pressure since January. Initially, the wound presented with exposed tendon in a 3X5 cm woundbed following a failed autologous graft attempt. The progress plateaued in March and the vac was removed with the tendon then covered with granulation and the size at 2X4 cm. The wound deteriorated and the vac was resumed in late April. It has now plateaued again and I am wondering if some other approach might enable me to finish this one off. The margins are rounding and I am thinking sharp debridement might be in order but the plastic surgeon in our community is reluctant to intervene due to the graft failure, the patient's unwillingness to stop cigarette smoking. We could probably keep her on the vac indefinitely to prevent regression but this is an expensive maintenance program. The problem is, as soon as the vac is stopped, the tissue becomes pale due to lack of perfusion and the deterioration begins again.
Anyone have a similiar experience and success with an alternate approach? The patient has already lost her other leg to a similiar problem which was left untreated. She is only in her mid 60s and would suffer for many years as a double amputee.
Thanks in advance for any advice.