Stewart-Bluefarb Syndrome
A 24-year-old male veteran presented with a 5-year history of a non-healing, painful left foot ulcer. Pertinent medical history related to the ulcer included osteomyelitis requiring antibiotics, multiple debridements, and skin grafting. His past surgical history was significant for a remote history of surgical intervention and endovascular treatment of an arteriovenous malformation (AVM) of the left lower extremity. Prior pathology specimens from a biopsy of the ulcer had revealed non-specific fibrogranulation tissue. Physical examination revealed a 6 × 2 × 0.2 cm ulcer on the dorsum of the left foot at the level of the second metatarsal head. The dorsalis pedis and posterior tibial pulses of the left foot were palpable. Transcutaneous oxygen measurements across the metatarsal heads and talus ranged from 39-49 mmHg. Due to his intractable pain and prolonged course of treatment for complications of his ulcer, the patient desired and subsequently underwent trans-metatarsal amputation for definitive treatment.
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