Lower Limb Ulceration Caused by Forgotten Elastic Band

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Limb Ulceration
Circumferential leg wound on presentation.

Case of circumferential ulceration in cognitively impaired man.

This article describes the case of a 79-year-old patient with limb ulceration caused by a circumferential application of an elastic band. The patient presented to the emergency department after referral from his GP for review of the ulcer on his left leg with a history of 2 weeks. His medical history was significant of type II diabetes. In addition, examination showed significant dementia and cognitive impairment. Although, despite the cognitive impairment and dementia, the patient was living alone. The patient stated that the ulcer had appeared after a fall.

The GP initially treated the patient with a 1-week course of antibiotics. However, no improvements were seen. Examination further showed that the patient that the patient was malnourished and cachectic with lower limb oedema. A circumferential ulcer, 2 cm wide was evident on the left lower leg. Wound myiasis with slough was also identified. Doctors dressed the wound and started the patient on antibiotics.

After wound care, doctors transferred the 79-year-old to a tertiary care hospital for review and management by the surgery and geriatric medicine teams.

Plain radiograph of the area showed a soft tissue defect in the absence of a bony abnormality. The circumferential nature of the wound led to the conclusion of a ligature type injury. However, the cause of the wound was still unknown, despite further questioning. Wound management further included elevation, compression, a dressing regime and antibiotics with future plans for grafting.

Debriding and removing the slough revealed a thin, tan coloured structure. Similarly, closer inspection revealed it to be an elastic band, causing the wound. The elastic band could not be seen earlier because of the thick slough around the wound. Doctors transected and removed the band. Even at this point, the patient was unsure of how the band got there

References

Forgotten Elastic Band as an Unusual Cause of Limb Ulceration: Case Report and Review of the Literature https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6664543/

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Dr. Aiman Shahab is a dentist with a bachelor’s degree from Dow University of Health Sciences. She is an experienced freelance writer with a demonstrated history of working in the health industry. Skilled in general dentistry, she is currently working as an associate dentist at a private dental clinic in Karachi, freelance content writer and as a part time science instructor with Little Medical School. She has also been an ambassador for PDC in the past from the year 2016 – 2018, and her responsibilities included acting as a representative and volunteer for PDC with an intention to make the dental community of Pakistan more connected and to work for benefiting the underprivileged. When she’s not working, you’ll either find her reading or aimlessly walking around for the sake of exploring. Her future plans include getting a master’s degree in maxillofacial and oral surgery, settled in a metropolitan city of North America.

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