Case 1

73-years old polymorbid patient, female, with arterial hypertension, type II diabetes, diabetic foot syndrome (left foot), critical limb threatening ischemia of left lower limb, obese, with metabolic syndrome, with mixed arterial-venous leg ulcer treated unsuccessfuly from 26^th september 2023.

On 3^rd october 2023 underwent femoral artery endarterectomy and femoro-popliteal distal bypass graft (prosthetic).

On 5^th december 2023 is patient diagnosed with bypass graft obliteration and with accelerated CLTI symptomes  including necrosis above V^th metatarsal head of left foot is indicated to surgical revision.

On 12^th december 2023 trombectomy and revision of proximal and distal anastomosis was realizied.

From 30^th january 2024 mixed leg ulcer was treated by Vulnamin Gel, but patient was diagnosed with osteomyelitis of the fifth metatarsal bone.

On 20^th february 2024 was realized an amputation of the fifth toe and exarticulation of fifth metatarsal on left foot. Enterococcus faecalis was cultered from bone and direct antibiotic treatment for several weeks was administered.

On 28^th february 2024 treatment with Vulnamin Gel started.

Mixed arterial-venous leg ulcer treated unsuccessfuly from 26^th september 2023.

30^th january 2023 – start of treatment with Vulnamin Gel, there´s “naked” periosteum without any granulation tissue on 50% of wound bed and stopped epithelisation from margins.

Almost complete graulation achieved on 12^th march 2024 and very good start of epithelisation.

After next two weeks (26^th march 2024) there´s “explosion” of epithelialisation above fully granulated wound bed

Left foot after the amputation (23^rd february 2024)

After 2 weeks of treatment with Vulnamin Gel there´s a significant improvement. Wound bed is fully granulated and wound margins are naturally closing the wound (12^th march 2024)

Only 4 weeks afte the start of our treatment, wound is only 3×1 cm and still closing. On X-ray there are no signs of residual osteomyelitis (20.3.2024). We achieved limb salvage for now.