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?

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OSTEOMYELITIS OF BONE

Pyoderma gangrenosum /livedoid vasculitis work up is needed

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

Send for biopsy.rule out varicose vein-trophic ulcer

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.

Pyodeema gangreonesum

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

Refer to plastic/ vascular surgeon

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

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