By David Davidson, DPM, Erie County Medical Center, Center for Wound Care, Buffalo, NY. email@example.com
History. A 41-year-old man presented with chronic ulcerations (7-year duration) along the medial and lateral aspects of both ankles. His medical history included T10 paraplegia (15 years), anxiety, chronic ankle wound infections resulting in hospital admissions, depression, and multiple suicide attempts. His medications included Ditropan (Ortho-McNeil-Janssen-Pharmaceutical, Inc) 5 mg bid, Seroquel (Astra-Zeneca) 25 mg bid, Dulcolax (Boehringer Ingelheim), Trazadone 50 mg bid, magnesium, and multiple vitamins. He denied alcohol or recreational drug use; he was a former cigarette smoker. He had been in the care of his primary care doctor, orthopedic surgeons, and vascular surgeons for multiple (failed) skin grafts and multiple spinal surgeries and other conventional wound care, but the wounds never resolved. He lived alone and, despite his paralysis (he is wheelchair-bound), seemed reasonably self-sufficient.