 The patient has a history of chronic ulceration to the right foot which has been treated on an outpatient basis with conservative methods Dr. X.  At this time, he desires surgical correction as the ulcer has been refractory to conservative treatment. 
The patient has a history of chronic ulceration to the right foot which has been treated on an outpatient basis with conservative methods Dr. X. At this time , he desires surgical correction as the ulcer has been refractory to conservative treatment .