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Case Study: Is it a Venous Leg Ulcer or Carcinoma?

Editor's Note: Matthew Regulski, DPM, FFPM RCPS(Glasgow), ABMSP, FASPM discusses a case where a wound had all of the hallmarks of a VLU but would not heal, and what he did to eventually heal that wound.

Case Study: Is it a Venous Leg Ulcer or Carcinoma? from HMP on Vimeo.


Hello, I'm Dr. Matthew Regulski. I'm the director of the Wound Institute of Ocean County, New Jersey, and I'm a partner with Ocean County Foot and Ankle Surgical Associates in Tom's River, New Jersey. I'm fellow faculty for the Royal College of Physician and Surgeons in Glasgow, Scotland, and triple board certified by the American Board of Multiple Specialties and Podiatry. I treat over 10,000 chronic wounds a year, and it's a pleasure to be here.

Can you talk about a memorable limb salvage case?

I do have a case, and it was on a venous wound, actually, because this is one of the stimulators of the Prepare to Repair paradigm. I had a new patient that came to the office, classic venous wound, medial ankle the area, inverted champagne bottle appearance of the legs, multiple varicosities. Total clinical signs of a venous wound, hemosiderosis, venosclerosis, all that. Afib, all these things that predispose that. So, I said, “hey, this is a classic venous wound. We're going to do this. We're going to do that. Vascular studies, X-ray we did, because you had a lot of calcification in the subcutaneous. But I noticed that in treating the biofilm, especially absorbing the drainage, managing the edema, but over time, and she had a nice, perfectly circular wound, which I thought was interesting, too. It wasn't scalloped. It wasn't undermined. But as I noticed, we were treating her for several weeks, and it really got a little better, but never really healed.

So eventually, I did do a biopsy, and it came back as a basal cell. So that was one of the reasons that I did develop the Prepare to Repair, because of all the thousands of wounds that I treat, you can't lose sight of the fact that these things can happen, that you have to cover all these steps each and every time you see a patient, or something gets missed. So, it was a basal cell, and I felt terrible because we were treating her for 8 weeks, to do good stuff for venous wound, but not having the right diagnosis because you'd think, oh, that's venous. Come on. There's the characteristics, the predisposition, the pathophysiology is there, but I got fooled on that.

So, given the fact, too, that she didn't have the wound open for long, it was only open for 2 months. Now, I could see if somebody had a wound that was there for a year, I would have biopsied it right off the bat. Easy, I would have done that, but I did not. So that is why you have to have a very low index of suspicion if something is not healing well, or if it just looks funny, a presentation is off, the history is off, then biopsy. Simple, easy, and you get the information. Now you can do a better job.

The views and opinions expressed in this blog are solely those of the author, and do not represent the views of WoundSource, HMP Global, its affiliates, or subsidiary companies.