Lower Limb Nonhealing Ulcers Associated With Chronic Diabetes: A Case Series

Chronic, nonhealing skin ulcers of the lower limbs associated with diabetes pose a clinical challenge as their treatment requires more sophisticated and delicate approaches than in patients without diabetes.

Herein, the authors demonstrate and discuss the implementation of their use of topical traditional Chinese medicines in several sample cases of lower limb nonhealing ulcers in patients with diabetes.

A series of diabetic ulcer cases were treated with various approaches. First, the approach employed with each patient was determined based on ulcer location, depth, inflammatory extent, and local circulation. Next, an exploratory incision was performed to evaluate eschar condition. Finally, the therapy applied was modified depending on specific case characteristics.

The primary therapeutic approaches employed were: (1) selective partial ablation, including fenestration and encroachment; (2) debridement, which avoids secondary injury when local circulation is good; and (3) the turning-over method, in which necrotic tissue is cleaned down to the basal layer via application of a topical Chinese medicine that reduces inflammation and promotes chronic ulcer healing.

These therapeutic approaches alleviated local inflammatory damage and adverse systemic reactions, which is an important basis for further treatment (eg, anti-infection treatment, blood glucose reduction, blood pressure control, organ function improvement, circulation promotion, and nutritional support).