An 81-year-old man with a history of hypertension, hyperlipidemia, and chronic lower extremity edema is following
An 81-year-old man with a history of hypertension, hyperlipidemia, and chronic lower extremity edema is following up at a clinic for an irregularly shaped, shallow wound on his right medial malleolus that has been present for 5 weeks. He tells the clinician that he has been using a combination of honey with calcium alginate and a foam dressing, but the wound has not improved. He reports no pain or an increase in drainage. A recent ankle-brachial index ratio was 1. On exam, the right lower extremity has significant edema, dry and flaky skin, hemosiderin staining, and a 3 cm × 4 cm × 0.3 cm full-thickness wound on the medial malleolus. The wound bed has a bright red color with no nonviable tissue, and there is a moderate amount of serous drainage. Which of the following is the most appropriate next step in management of this patient’s condition? Initiate compression therapy Initiate hyperbaric oxygen therapy Prescribe furosemide Switch honey with calcium alginate to collagenase
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