A 75-year-old woman who has diabetes mellitus and is morbidly obese presents to you with an ulceration on her right lower extremity (see Figure).
Figure.
She tells you that it has been present for 4 months, and that the ulceration started as a small opening in the skin after she bumped her leg on a piece of cardboard. Since then, the lesion has become progressively larger in size.
The patient tells you that she has been using topical antifungal creams, antimicrobials, and hydrogen peroxide to treat the wound. She also has been using rolled gauze to keep the area covered, but the lesion has increased progressively in size. What bothers her the most is a large amount of serous drainage that requires changing the dressing 3 or 4 times a day.
On physical examination, she has a large ulceration. There is overall red granular tissue visible. There are changes suggestive of stasis dermatitis both above and below the leg ulcer. There is prominent edema.
What is the most important therapy in this case?
This question appears in Med-Challenger Internal Medicine Exam Review with CME
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