I have a open skin in the foot measuring 1" x 1" for two years, even after skin grafting not covered, to develop skin to get clean foot what is the remedy?
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Hi. From your description you have an open wound in your feet since 2 years which has not healed yet, so there is an ulcer which is non-healing for 2 years. Kindly get a biopsy from edge of the wound to rule out marjolin's ulcer which is a well differentiated squamous cell carcinoma. Unfortunately if it turns out to be marjolin's ulcer wide excision has to be done otherwise it can turn into poorly differentiated squamous cell carcinoma with a poor prognosis. This is however very-very rare. Now coming to common possibilities. As you are a diabetic get an fbs, ppbs and hba1c done. If sugars are elevated there will be more chances of infection so, if sugars are elevated control it preoperatively, otherwise there will be chances of graft failure due to infection. A swab can be taken from the wound and sent for culture to start correct prophylactic antimicrobial management and once culture shows negative growth grafting can be planned. Local application of silver nitrate cream serves as an antimicrobial as well as stimulates granulation. Synthetic dressings like hydrocolloid dressings which helps epithelization or integra in which deeper collagen acts as dermis and outer silicone sheet acts as epidermis can be used. The outer silicone layer is removed after 2 weeks followed by autograft can be done. Biologic dressings like xenograft or allograft can be used to temporarily cover the wound and once this layer sloughs auto graft can be used. Finally full thickness skin biopsy of patient's skin is done on admission. By specialized culture technology sheets of skin can be manufactured in 3 weeks and take up of cultured graft is 60-75% washing the feet pre-operatively in a bucket of lukewarm water with soap solution (pedicure) for 1-2 months can reduce the bacterial load of the wound and can reduce the chances of post-operative infection. Hope the consultation was beneficial. Regards.
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