The Value of ABPI

Case Scenario:

Mr. P is a 60 year old male patient with a history of arterial insufficiency he had a fem-pop 16 years ago.  Was admitted to hospital 5 weeks ago with severe cellulites, extensive bilateral wounds and "arterial insufficiency".  Health Practitioners discussed above knee amputations with patient due to severity of the problem.  Patient discharged himself from hospital one week ago after being on Ciprobay for 3 weeks (he completed the course).

First consultation at Centre of Excellence - Bounding foot pulses, clinical signs of venous hypertension with lipodermatoscerosis as well as oedema.  Patient is a smoker and also hypertensive.  Ankle Brachial Pressure Index was done by using the new Huntleigh Ability Diagnostic Device Left leg 1.06 and Right leg 1.03.  No arterial insuffieciency a normal reading.  Wounds were sloughy with senecents cells and signs of biofilm and an increased bioload.  Wounds were dressed with Sorbact Hydroactive (in order to decrease bioload and facilitate autolytic debridement) and Compression Bandages (to address underlying venous hypertension and venous insufficiency). 

Follow up consultation after 3 days - all wounds decreased in size with signs of healthy granulation and epithelial tissue present.  Slough and biofilm were removed via sharp debridement.  Oedema also decreased and overall patient improved significantly.  Wounds were dressed the same way with Compression bandages.  Patient was able to walk with ease and pain decreased to 3/10.

Perhaps the questions that need to be answered are:

• Was there ever an ABPI measurement done during the last month?
• Why was amputation even considered in a case like this?
• Why 3 weeks antibiotics with no biopsy?

It's about getting back to basics first treat the cause and determine the diagnosis as well as the patient centered concerns before you address local wound care.  In this case the cause was Venous Ulceration since the arterial problem was dealt with.  The patient centered concern was fear, decreased quality of life as well as pain.  Local wound care:  Wounds needed debridement and moist wound healing principles together with Compression therapy.

What was great about working with this patient: to change his quality of life, and to be able to make a difference without using the most expensive methods available to us. And also to be able to see a difference in only 2 consultations.  Can't wait to see the end result!