A Rare Case Report of Complete Closure of an Infected Diabetic Foot Ulcer In a Patient with Metastatic Endometrial Adenocarcinoma and Lower Extremity Lymphadema

Introduction: The purpose of this study is to demonstrate the complexities of wound healing efforts with patients who have a history of chronic pedal unilateral ulcerations caused by osteomyelitis localized to the foot secondary to diabetes mellitus with lymphedema, and concomitant acute chemotherapy and radiation therapy for metastatic cancer. The primary targets of radiation therapy/chemotherapy are rapidly dividing cells, including keratinocytes, fibroblasts, melanocytes, endothelial and immune cells. These are the same cells responsible in healing of a wound. One of the major complications of adjuvant chemotherapy and radiation therapy are wound healing complications including when acute surgical wounds are susceptible to impeding growth and converting into a chronic ulcerative state by way of multiple metabolic mechanismsMethods:We present a rare case report of a 60 y.o. female who presented for an infected non-healing ulcer to her right heel with significant past medical history including lymphedema, congestive heart failure, diabetes, ESRD, hypertension, and obstructive sleep apnea. The patient was diagnosed with stage IIIB metastatic endometrial adenocarcinoma during her management of her ulceration. The infected non-healing ulcer was managed with serial surgical debridements, a full thickness rotational flap and an application of MTF Biologics Somagen Graft in conjunction with antibiotic therapy. The ulcer was with complete closure in 10 months after the first surgery.Results:Despite the contradictions of delayed wound healing while receiving radiation therapy/chemotherapy, the patient went on to heal the chronic wound with complete closure prior to her expiration. We believe that the surgical techniques mentioned in our study, as well as others, are applicable for chronic diabetic foot ulcers while receiving acute treatment of metastatic cancer with radiation therapy/chemotherapy. The ulcer was with complete closure in 10 months after the first surgery.Discussion: Ongoing investigated treatments have allowed for surgeons and wound care specialists to continue seeking appropriate treatments such as surgical resection and excision, well-vascularized rotational flaps, and the use of allograft for adequate coverage of diabetic foot. Although radiation therapy/chemotherapy may delay or cause non-healing to diabetic foot ulcerations, this case demonstrates that complete closure is possible with appropriate surgical management in conjunction with antibiotic therapyReferences:Deptuła M, Zieliński J, Wardowska A, Pikuła M. Wound healing complications in oncological patients: perspectives for cellular therapy. Postepy Dermatol Alergol. 2019;36(2):139-146. doi:10.5114/ada.2018.72585