13 year old female sustained cut injury of left heel by two wheeler back wheel while travelling one week back.. sutured in local hospital. now she's unablena to walk. history burning sensation in the sutured area.. now wound turns black and leaking serous fluid.. Wat would be the cause.. treatment? X ray normal.. no bone involvement..
SUTRES SHOULD BE REMOVED. RULE OUT GAS GANGRENE. REMOVE THE DEAD TISSUE. INJECTION T.T SHOULD BE GIVEN. RINSE THE WOUND WITH NORMAL SALINE THEN WITH POT. PERMAGANATE. AND LASTLY WITH BETADINE SOLUTION.APPLY FUSIDIC ACID POWDER OVER THE WOUND. START HIGHER ANTIBIOTICS, CEFIDINIR, VANCOMYCIN AND NSAID WITH PAIN KILLERS LIKE TAPENTADOL.....VIGROUS TREATMENT IS THE NEED OF THE MOMENT . IF PATIENT IS NOT SENSITIVE TO PENCILLIN THEN START BENZYL PENICILLIN 6 LAX UNIT B.D. SEE THE RESULT.
In this case it looks like while suturing the aseptic conditions were not considered and as a result the wound got infected so discharge is present . Send pus culture and sensitivity and accordingly prescribe antibiotics . Higher antibiotics would be preferred. Take surgery / orthopaedics opinion for this wound . Take proper history and evaluate for DM/ Any other underlying condition . Elevate / proper cleaning and wound debridement with dressing needed . Check vitals if fever / BP is concern . R/o sepsis also .
Marginal skin necrosis Heel flap may be infected One option is open the wound,:take culture from depth. Excise necrosed skin Inspect the heel flap Wound wash and loose approximation of skin Make sure tendoachilles insertion is intact Plan secondary closure Iv antibiotics
start with broad spectrum antibiotics, send pus for culture, and also get x ray done, rule out underlying conditions like diabetes, if there is no improvement with antibiotics, then patient will require debridement and drainage
Thorough cleansing of the wound under la/ga. in case of fb in the form of dust gravel or metal piece may be there causing wound infection at a deeper level. Do not close the wound . Take culture from debriefed gangrenous tissue give gram negative cover . I feel will be ok soon .
It look like infected wound associated with pus collection of Pus(abscess) exploration should be done and thorough. washing with anti septic solution, and daily dressing antibiotics according to culture sensitivity
case of soft tissue infection..treat as abcess..debride the local necrotic tissue.putbon broad spectrum antibiotics and dressing till the wound heals
send pus culture before starting antibiotics. xray to rule out any injury. open, debride, explore to check TA
remove sutures under la/ga do debridment infection needs higher antibiotic
It looks like wound infection do fluid cs antibiotic ac culture daily dressing
Cases that would interest you
- Login to View the image
55/M. known diabetic. no other co-morbidity. presented with the following condition since last two months. c/o pain. no fever/no systemic complains. b.sugar at admission 110. other blood investigations - report due. Dx and Mx
Dr. Pranay Gourav3 Likes17 Answers - Login to View the image
55 year old diabetic lady presented with wound and discharge from right thigh and knee area since 20 days. O/e Pale, vitals stable RBS 180mg/dl L/e: scab with gangrenous tissue Slough with purulent discharge. systemic examination:WNL
Dr. Nyemwang W Konyak4 Likes20 Answers - Login to View the image
Good Morning Curofians ,Here is a case of a female patient aged about 50 years got these types of lesions on left foot . On enquiry ,she told some 10 days back she got some nail infection of big toe and she also got history of ingrowing toe nail of greyer toe ,of left foot . Kindly suggest the diagnosis and management of the case .Yours sincerely .Rajesh Gopal MBBS IMA PMC Reg no 35726.Ludhiana . Patient is not a diabetic .
Dr. Rajesh Gopal6 Likes32 Answers - Login to View the image
Dog bite 3 days back presented to ED having complaints of pain.H/o of fever with vomitting.How to manage?
Dr. Prashant Ved11 Likes27 Answers - Login to View the image
48 yrs male patient known case of diabetes, on irregular treatment chronic alcoholic had infection of right foot since 15 days on presentation the condition of foot as shown in picture there was palpable crepitus on dorsum of foot approaching lower leg the discharge from foot was foul smelling Hb 10 gm/dl WBC 23,000/ cmm S. creatinine 2.5 mg / dl kindly suggest management
Dr. Jayesh Kalbhande2 Likes19 Answers
2 Likes