Using standard treatment and offloading principles to heal a wound of a patient who ambulates upon “all fours”

Background A 71 year old, weighing 80 kg was referred to the Foot Wound Clinic despite not having feet. The patient had suffered a traumatic Above Knee Amputation of the right limb and an Above Knee Amputation of the left limb from the same incident in 1969. The patient ambulates on “all fours” or upon the femurs alone and continues to work full-time as a landscaper. The patient presented for review of a wound over the right stump with the expectation that he would undergo surgical debridement and a skin graft. The patient had adequate arterial flow therefore with standard wound care and offloading, healing should ensure. The patient has been referred to Rehabilitation Services for review and in the interim consented to being treated with a Total Contact Cast (TCC).