Clinical Problem: A 76 year old male with a history of IDDM, CAD, left foot cellulitis, left foot partial amputation, and morbid obesity with two full-thickness diabetic ulcers. Both wounds have existed for over 6 months. Both were covered in a light yellow slough. No granulation was evident. The left dorsal mid-foot wound (henceforth #1)measured 2.3 x 1.3 x .1 cm and the left 5th toe amputation site (henceforth #2) measure 1.4 x .6 x .1cm on 7/25/06.

Description of past management: Wet to moist dressings were used for 3 months followed by Silvadene cream. Conservative sharp debridement had been performed. His nutrition, hydration, pressure off-loading, friction, shear, as well as pain had all been addressed.

Current Clinical Approach: Both ulcers were cleansed with NSS. The composite* was cut to size to overlap the edges by 2cm. The printed side was placed face up with the plain side in direct contact with the wound bases. The initial dressing was left intact for three days and then the frequency was backed to every seven days.

Patient Outcomes: On 8/1/06, #1 measured 2.2 x 1.3 x .1 cm and #2 measured 1.3 x .5 x .1cm. Both wounds elicited a decrease in slough with some granulation budding noted. On 8/10/06, #1 measured 2.1 x 1.1 x .2cm and #2 measured 1 x .5 x .1cm with both wound beds fully clean and granulating. On 9/20/06, #1 measured .9 x .4 x .1cm and #2 measured .5 x .3 x .1cm. Full healing was attained by 9/27/06.

Conclusion: The ionic silver composite dressing* was effective for the management of the recalcitrant diabetic ulcers in this patient. *SilverDerm 7 Plus References: 1. Krasner, Rodheaver, Chronic Wound Care, 2001, pages 591-594 2. DermaRite and Milliken Labs, 2005, FDA product insert.