35 yr old male came with history of non-healing wounds on both legs since 5-6 years, purulent, foul smelling discharge present. No h/o trauma, no h/o long term medication, no h/o diabetes.. Patient took treatment from several doctors and RMPs before.. But not relieved. Diagnosis and management?



Get a colour Doppler study of lower limb vessels to rule out peripheral vascular disease or varicose veins . Apparently it looks like a stasis ulcer which is commonly seen in varicose veins. Varicose veins if present need to be treated by laser photo ablation. To rule out any other disease like tuberculosis, syphilitic ulcer, malignancy, edge biopsy from the lesion is required. Also rule out DM, Or other immunodeficiency disorders. Debridement of the wounds and skin grafting is required

These ulcers seems to be avn(avascularnecrosis of skin). Yes skin biopsy from margins is suggested.they can heal by simple normal saline dressings.but you have mentioned foul smelling discharge from wound .so it indicates anaerobic infection sosend discharge for c&s than start antibiotic accordingly.till than clean debride the wound and dress with meterogyl oint or placentrax oint.once wound granulates and margins are healthy and not approximating than skingraft can be thought of.

Looks like a venous ulcer. Doppler study of both the limbs to be done. If varicose vein is there to be treated by laser photo ablation. Scrape cytology to be done to rule out malignancy . Proper debridment & dressing to be done, Broad spectrum antibiotic has to be started. After good control over wound, Skin grafting to be done.

Exclude ch.OM with vascular disorder.Inj.ceftraxizone1.5+Tazabactum.BD×5days.Dailly wound cleaning by betadine lotion.Dressing by Megaheal/Metrokind_m.Tab Chymocad BD/pc

incision biopsy of the two ulcers. Exclude varicose veins by doplar scan . it appears to be TB ulcer . exclufeDM. Review with leg xrays and reports. og scan and biopsy

Clean & remove the debridement by Betadine lotion daily and dressing by.dterile vaseline.gauze under the antibiotic. After granulation skin grating.

आयुर्वेद के अनुसार यह दुष्ट व्रण है। चिकित्सा संबंधी योग,, गैंदा के फूल और हल्दी को गाय के मूत्र में पीसकर लेप करें और फिर उस पर पट्टी बांध दी जाती है। अगले दिन सुबह गाय के मूत्र से धो लें और फिर यही कार्य करें। मृत्युंजय रस स्वर्ण युक्त 1 रत्ती भर सत गिलोय 4 रत्ती भर शहद मिलाकर सुबह-शाम सेवन कराएं निश्चित रूप से लाभ होगा योग परिक्षित है पिछले 40 वर्ष से प्रयोग कर रहा हूं

Start augmentin IV daily for7 days. Along with augmentin 625half tablet. bd. And drez S ointment over the wound two time. PPI add. For lower gastric irritate. If burning sensation is there just add becozinc. And itching add Avil 25mg. Bd. Or Levocetrizine bd. will be helpful

Looks like pyoderma gangrenosum.Any history suggestive if Inflammatory bowel disease? A biopsy would throw light on the diagnosis. He could be treated with sulfasalazine 500 mg bd to start with,increased to tid Or after ensuring he isn't anaemic,he could be put on Tab.Dapsone.

Colour doppler of both lower limbs to rule out varicose veins/ c&s test from the secretions, parentral antibiotics, wound debridement with metrogyl dressing, any lymphadenitis? R/o autoimmune disease/ tb

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