Carolinas HealthCare System

In September 2011, when Rose Ross found a small cut on her big toe, she didn’t think much of it. But while on vacation, she started to feel sick and noticed the wound on her toe was getting worse.

Rose Ross and Holly Nestlerode, RN
Rose Ross and Holly Nestlerode, RN

By the time she returned home from her vacation, Ross’ toe was severely infected. She went to the emergency department at Carolinas HealthCare System Cleveland where she was admitted to the hospital and had surgery on her toe the next day. "My whole foot was infected and I had gangrene to the bone," Ross said.

Things became more complicated when Ross developed another injury on her leg. "The second wound showed up originally as a huge blister caused by all the swelling she had from the toe infection," said Holly Nestlerode, RN, who worked with Ross in the Wound Healing Center.

"The wounds got so bad that I couldn’t walk well," Ross said. "I couldn’t drive a long distance, or stand up long to do housework or cook for my family.” One thing complicating Ross’ problem was her diabetes.

"We were very concerned about Ms. Ross," said Johnson Kelly, MD, a wound specialist who treated Ross in the Wound Healing Center at Carolinas HealthCare System Cleveland. "When she came to us, her diabetes was not well controlled."

Uncontrolled diabetes can easily complicate the healing process, making it difficult, if not impossible, for wounds to heal. That was the case with Ross. "I wasn’t healing at all. They gave me antibiotics, but at my next visit the wound still wasn’t healing as well as they wanted."

Another surgical procedure was performed to clean out the tissue in her toe to promote healing, but nothing was working well. Dr. Kelly decided to try hyperbaric oxygen therapy (HBOT), which places a patient inside a sealed chamber where they breathe 100 percent oxygen while under increased atmospheric pressure. The increased pressure allows the lungs to gather more oxygen than possible at normal pressure and pass it to the red blood cells. The oxygen-rich blood traveling throughout the body stimulates the release of growth factors and stem cells, which promote healing.

"I came to the Wound Center five days a week for about nine weeks for that treatment," Ross said. Being placed in an oxygen chamber was a little intimidating but, she said, "It wasn’t as bad as I thought it was going to be, and it was worth every second."

In the meantime, her lower leg needed some serious attention. "Basically, I had a hole in my leg that went to the bone," Ross said. During the HBOT treatment series, Dr. Kelly also applied negative pressure wound therapy to the leg. Negative pressure wound therapy promotes healing by applying a vacuum to the wound through a special sealed bandage. The vacuum draws out fluid from the wound and helps increase blood flow to the area. This process helps encourage new skin growth to close the wound.

With help from the Wound Healing Center staff, Ross established a relationship with a primary care physician, and received education about managing her diabetes and how to take better care of herself. After about seven months of treatment, both of Ross’s wounds were healed. "Holly had faith in me and took care of me," said Ross. "They all took care of me."

"Things really started to turn around for her when she started seeing a primary care physician," said Nestlerode. "She began watching her blood sugar levels and never missed a wound care visit or HBOT treatment."

"Ms. Ross came to us as a non-compliant diabetic patient, but she became one of the best patients we’ve ever had," said Dr. Kelly. "She took control of her life."

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