This is serious--My mother has a 2" x 1 1/2" wound that is 1/4" deep. It is not healing & she is not diabetic.

She is under a Dr.'s care right now & has been for about a year for this one wound. It keeps growing no matter what they try. It started out as a tiny scratch-scratched by what, I don't know. She is, and has been, in tremendous pain that she dims with the pain meds the doctor gave her. She has been tested for diabetes 3 times--she doesn't have it. She has been tested twice for Mercer's and other "flesh-eatting" diseases--she doesn't have any of those. She has been tested and examined by at least 4 different doctors--NO ONE HAS A CLUE! I would be forever in debt to whoever can help my mother. ANY suggestions are greatly appreciated because I am afraid she may lose her foot, maybe her leg or worse.

a type of autoimmune disorder or blood dyscrasia

remain alert to the potential for longstanding wounds to deteriorate into malignant lesions that may present as hypergranulating wounds. A biopsy should be done if this is a possibility.

patient lacks the needed calories and protein to heal the wound,

perfusion to the wound is inadequate, the patient is chronically hyperglycemie,

or the patient is receiving steroids at doses greater than 30 mg/day. In assessing nutritional status, the clinician should evaluate albumin and prealbumin levels, the patient's weight trends, and the patient's current nutrient intake (wound healing generally requires 30 calories and 1.5 gin protein/kg body weight/day). Patients with significant wounds should also receive a multivitamin supplement. Individuals on high-dose steroids may benefit from the application of topical vitamin A to the wound bed.

Impediments at the wound surface. This may include high bacterial counts, closed wound edges, high-volume exudate, or drying of the wound surface.1'4'6 A particularly common problem is bacterial counts on the wound surface that are high enough to interfere with the repair process. Surface-level infection is indicated by persistent high-volume exudatc, sudden deterioration in the quantity or quality of granulation tissue, repeated formation of a thin layer of avascular tissue, and increased pain.

When a wound is identified as potentially nonhealing, a comprehensive review of the care plan should be initiated, with emphasis on the following:

correction of causative factors-Has something been missed? Is the care plan being followed consistently?

* systemic support-Is there evidence of ischemia? Is nutritional status adequate? Is the patient on steroids? What about the blood glucose level?

* topical therapy-Is there any evidence of critical colonization and, if so, has it been treated effectively? Is the wound bed clean and moist? Is exudate controlled? Are the wound edges open?

If the care plan is deemed appropriate and is being followed, it is time to consider an active wound therapy. Two commonly used active wound therapies are negative pressure wound therapy (vacuum-assisted closure [VAC]) and exogenous growth factors (becaplermin [REGRANEX]).8

VAC is particularly appropriate for large wounds that are exudative and wounds that are slow to granulate; negative pressure eliminates the wound fluid and alters cell shape, thus stimulating intracellular repair processes.

Because patients with diabetes have demonstrated low levels of growth factors, becaplermin may be a good choice for diabetic ulcers that are clean and uninfected but slow to heal.

Focus initial wound care on correction of causative factors, systemic support, and appropriate topical therapy.

* Conduct a comprehensive assessment of wound status to quickly identify nonresponders, such as wounds that fail to show measurable progress after 2 weeks despite appropriate care.

* Initiate a review of the care plan to ensure that all elements are in place. Note the potential for persistence of causative factors and/or high bacterial counts on the wound surface.

* Consider using active wound therapies for wounds that fail to respond with no apparent cause

check into a wound clinic nearby

Unfortunately, more information is needed for a complete diagnosis... Plus, well.. I'm not a doctor. I only play one on the internet.

It sounds as though she is receiving the proper care. As to why the wound is degenerating, well... Again, more information is required. I'm guessing she's gone through the full swath of tests for viral and bacterial agents, not just the 'flesh eaters' out there. For the sake of assumption, we'll assume so.

The origin of the wound may be a large factor in this equasion. How did she get it? When and where? Not often does a tiny scratch turn that septic.

Something that may be looked into is venoms. There are a number of different spider toxins that can cause degenerating wounds of this type. The poison itself almost acts like an acid, destroying flesh and causing a cavitated, septic wound that can continue to grow. These wounds, however, do tend to stabilize and cease to grow after a certain amount of time... Though often they *never* go away. And, if she had/has a slight allergic reaction to this sort of venom... The results can be startling.

That may not be much help however. Another possibility to consider is nerve and circulatory damage in that area. If a small vein or cappelary (sp?) was severed or pinched, it could conceivably cause the sort of damage you're describing. In that case, she'd have to see a very talented neurologist to detect the damage...

Sorry I couldn't be of more help.

Go to another doctor and keep going to others untill they get this figured out. You are right to be worried and keep pushing the doctors untill they find the problem. Some doctors tend to get lazy and see patients are numbers and they need pushed. You could also go to a would clinic and see if they could help.

What kind of Dr is she seeing? There are plastic surgeons that deal with difficult to heal wounds.
She may not be a diabetic but is she has poor circulation in her legs, that by itself is enough to keep the wound from healing.
Has she been checked for antibiotic resistant infections? Those wounds are hard to heal and need lengthy antibiotic treatment, up to 12 weeks sometimes.
There are wound clinics in most hospitals. Check the hospital in your area.
A second opinion would not hurt if she has been seeing the same Dr for this whole year.
Good luck to both of you!!

Get your mother to a health risk management ctre this would help get to the bottom of the findings. There are wound care specialists that went to be on the move.