Critical limb ischemia (CLI) is common in patients with peripheral artery disease (PAD) and concomitant diabetes. Minor leg or foot trauma may lead to ulceration in patients with PAD and diabetes. These patients are at risk due to microcirculation damage and associated diabetic sensory neuropathy and neuroischemia. The reduced ability to combat infection resulting from poor perfusion in patients with diabetes worsens the ulceration. A 63-year-old man presented with right foot dynia and an ulcer that had been present for 6 years. Initially the patient developed an ulcer on the plantar aspect of his right foot. The ulcer worsened and required amputation of his 1 st , 2 nd , 3 rd and 5 th toes about four years ago. Since then the ulcer was slow to heal despite debridement, courses of antibiotics and visits to diabetic foot clinic. He later presented with severe pain and was admitted for management with prostaglandin E1 (Alprostadil). There was complete healing of ischemic necrosis and ulceration in the patient treated with 60 mcg of prostaglandin E1 (Alprostaldil) in 250ml of isotonic NaCl solution q3h for 15 days.
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