Chronic Arm Wound with Suspected Necrosis and Functional Impairment

Case at a Glance

A 35-year-old male presented with a chronic arm wound of several months' duration, showing signs of tissue necrosis, functional impairment of the wrist and hand, and patient non-compliance with medical treatment recommendations.

Patient's Story

The patient, weighing approximately 85kg and 170cm tall, sustained a traumatic arm injury several months prior. Initial history suggested an animal bite, though the mechanism of injury remained unclear. He received initial medical evaluation and was prescribed antibiotics but failed to maintain follow-up care. The patient reported persistent pain and progressive loss of hand function, with significant limitation in wrist mobility and grip strength.

Initial Assessment

Physical examination revealed a large tissue defect on the arm with visible deep structures including what appeared to be muscle and tendon. The wound demonstrated areas of black discoloration consistent with tissue necrosis, surrounded by erythematous and pale tissue in concentric rings. The wound was dry without active drainage but had a characteristic odor. Functional assessment showed marked limitation in wrist range of motion and hand strength. The patient appeared to have adequate cognitive capacity to understand treatment recommendations.

The Diagnostic Journey

The clinical presentation suggested chronic wound with tissue necrosis, possible deep structure involvement, and secondary functional impairment. Differential considerations included osteomyelitis, deep space infection, vascular compromise, and nerve damage. The chronicity and appearance raised concerns for progressive tissue death and potential systemic complications.

Final Diagnosis

Chronic traumatic arm wound with tissue necrosis and functional impairment; patient refusing recommended surgical intervention and ongoing medical management.

Treatment Plan

Recommended immediate surgical evaluation for wound debridement, assessment of deep structure viability, and possible reconstructive procedures. Antibiotic therapy, wound care management, and rehabilitation services were indicated. Social work consultation was suggested to address barriers to care compliance.

Outcome and Follow-up

Patient continued to refuse recommended medical intervention despite counseling regarding risks including potential amputation, sepsis, and mortality. Case highlights the clinical and ethical challenges of managing severe wounds in non-compliant patients with decision-making capacity.