Difficult case

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I would appreciate any input regarding a patient:

He is 48 yo with ESRD, DM, and PVD- overall a frail weak constitution. He is on a list for a kidney transplant. He presented about 4 months ago with a rather large mismanaged decubitus ulcer to his lateral heel. It had a thick eshcar that I removed in the office and treated the underlying slough with enzymatic dressings. I then progressed him to Regranex and things are contracting and granulating nicely. The wound is now 3x4cm. The only problem is an area of dried exposed bone (calcaneus) approx 75 mm in diameter at the upper edge at 2 o'clock. I had hoped, pessimistically, that this area would granulate over.

The issue is that his co-morbidities make him a very poor surgical candidate so I have been moving slow with regards to this area of bone. However, this wound is keeping him from getting a kidney- if and when he's called. Any thoughts on the best way to treat this??

Thanks

 

I would say just observe it and if it's stable leave him be.He is in a very weak condition and you do not need to cause further problems.