How would you manage this wound on the elbow?

In this week's discussion, we look at a case from Dr Dipankar Chakraborty in which a 71-year-old male patient presented with a non-healing ulcerated wound on the left elbow, with a secondary wound below the larger wound on the same site. 

What do you think of this case?

Update

Multiple dressings and swabs showed staph aureus, so multiple courses of antibiotics were given with no improvement. Finally a punch biopsy was performed which showed focally granulomatous inflammation. Special stains were performed by histologist which confirmed acid fast bacilli.

This is a case of cutaneous tuberculosis which is a very rare condition with epidemiological and infectious disease significance, needing long-term treatment, contact tracing, and probable infection control measures.

The secondary infection of staph aureus was treated with flucloxacillin. Cutaneous tuberculosis requires full treatment with anti-tuberculous drugs. The patient is now being managed by the hospital infectious department.

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