Difficult Leg Ulcer

The patient is an otherwise healthy 84 y.o. woman with a two year history of a progressively expanding and debilitating leg ulcer.  It has not improved after attention from three wound care centers (two of which were associated with medical schools).

This woman, a compliant retired teacher, is depressed about her debilitating leg ulcer; especially so since her PCP has been talking about "end of life care."What can we do to put life into her years?

Photos taken by her visiting nurse.