The Progressive Pligmologist: Case Study November 2025

This was a pleasant 81 year old male with severe peripheral vascular disease who underwent an urgent left lower extremity arterial bypass surgery in a hospital in rural Tennessee. After undergoing this intervention, he was transitioned to a skilled nursing facility for rehabilitation and wound care. Unfortunately, on arrival his IV antibiotics were discontinued; he also reported interruptions in appropriate wound management, and subsequently discharged prematurely due to dissatisfaction with his care. 

He was brought into our clinic and was seen several the severe left foot arterial ulcers, infected, with bone involvement and tunneling. We had long discussions regarding options for management including amputation, which was considered unacceptable, and we initiated routine management with hydrofera blue classic for slough management, followed by collagen. Despite a history of PVD, we used mild compression, to which he responded very well.  Several instances of worsening required intermittent IV and oral antibiotics, but over several months he achieved closure of his wounds and did not require amputation or surgical debridement. Ultimately, for concern of a prosthetic knee and concern for possible ascending cellulitis leading to prosthesis compromise, we decided to maintain him on low dose suppressive antibiotic.