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
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/