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A 79-year-old woman presented
with an ankle ulcer of several years duration. The
right lateral malleolar area was inflamed with eczematous
dermatitis. The wound base had granulation tissue
indicative of sufficient arterial circulation and
intrinsic wound healing competence. However, there
was persistent active ulceration and failure of
epithelial ingrowth. Workup for all of the usual
culprits failed to make any diagnosis other than
chronic pseudarthrosis at an old malleolar non-union
directly under the ulcer. The significance of tissue
mechanics and their influence on mesenchymal differentiation,
repair, and pathology should never be overlooked.
The cardinal signs of pseudarthrosis are inflammation
and pain, and in a susceptible elderly person, it
can create enough local pathology to maintain an
active ulcer.
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The ulcer did not close with improved
topical care and splints, so surgery was done. It
was excised, including bone fragments and the arthrosis,
and Integra was used to close the wound and the
structures underneath. Seen here 11 days later,
periwound inflammation is gone.
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The wound healed and has remained
so, seen here one year later.
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Cases Courtesy of:
Marc E. Gottlieb, M.D., Jennifer Furman
Journal of Burns and Wounds, Vol 3, #2
