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..

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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.

thank you sir
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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 .

I removed the suture and cut the gangrenous tissues.. starting cefuroxime and metronidazole.. is it enough sir?
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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

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