Need help on a concept map issue

[Idaho Murse]

I am doing a concept map, my patients Nursing Dx is Delayed Surgical Recovery. Here is the problem, he wants a medical Dx related to our Dx. So my patient has 2 wounds with wound vacs on his LLE one wound is 24x20cm and the second is 15cm x 15cm. He has diabetes, HTN, atrial fibrillation, is morbidly obese, a 70pack year habit, and many "beers" a night. He originally came to a doc in the box clinic for a cut on his leg. Poor healing landed him into a facility where the wound team was unable to get control on it. He went in for surgery to have the wound debrided. He was sent back to the rehab unit afterwards where he then got infected and is "growing many cultures" including pseudomonas. Got a second surgery and this is where he became my patient. He has so much going and so much patho working against him I have having trouble with his med Dx. I looked all through his chart and I must have been blind because I could not find it anywhere besides what I have listed here.

Essentially I am tying DSR to decreased perfusion. Because he is so obese(lack of blood supply to site), with vasoconstriction(HTN), Nicotine(smoking-vasoconstriction), diabetes(hyperlipidemia). The problem is I need a medical diagnosis to be semi central to this. And for the life of me I don't know what to put and I know its staring at me in the face, but its like trying to see a tree through the forest(i know that metaphor is backwards) if you know what I mean.