Four cases of lower extremity ulcers treated with negative pressure therapy

We report on four cases of lower extremity ulcers treated with negative pressure therapy (NPT). Case 1: A 74-year-old man with an ulcer on the left great toe was diagnosed as grade IV of Fontaine classification, and an endovascular treatment was performed previously. However, due to progression of necrosis of the left great toe, he was introduced to our department, and an amputation of the left great toe's metatarsal was performed. After surgery, wound closure was delayed, and widespread inflammation of plantar muscle was observed by MRI. After debridement and four weeks of treatment by NPT, wound closure was achieved. Case 2: An 80-year-old woman had redness, swelling, and warmth of the right lower leg. We had a diagnosis of cellulitis, and started treatment with antibiotic. There was a swelling of the right top of the foot, an erosion appeared gradually, and an ulcer developed at the same site. After four weeks of treatment by NPT, a reduction in the size of the ulcer was observed. Case 3: A 90-year-old woman visited our hospital's emergency room with a right lower leg ulcer that developed after a fall. Following debridement of necrotic tissue, an ulcer was seen that reached above the fascia; after four weeks of treatment by NPT, a reduction of ulceration was observed. Case 4: A 59-year-old man developed an ulcer from a corn on the bottom of the left foot, at which site he had suffered repeated infection. A fistula formation with a pinholelike appearance was also seen. Osteomyelitis was suspected by MRI. We performed debridement and treatment with antibiotic, and then after four weeks of treatment by NPT, wound closure was achieved.