45yr male, T2DM presented with high grade fever, swelling of leg with bleb ..diagnosis n management ??



This is a real challenge for the treating doctor, as this seems to be worsened by uncontrolled T2DM, infection resulting in a very deep cellulitis, really a limb threatening situation. First of all conunsel the whole family members including the patient, tell them that this is a limb threatening situation, may go until a stage of above knee or below knee amputation, take high risk consent from all, then admit the case. Coming to the treatment part there are three aspects in this case, first is to control the blood sugars maticulously with Insulin, a basal bolus regimen, r/o systemic diseases like , if you observe carefully left lower limb is grossly swollen, r/o Hypothyroidism or Myxedema,DKD,CKD,CRF order the routine investigations including HBV,HCV,HIV,TFT,RFT,Serum Electrolytes, CBP,ESR before starting the treatment. Meticulous wound debridement must be done by liberal fasciotomy, daily dressings, meticulous slough excision, please do not use Hydrogen peroxide, or Spirit for irrigation, use only NS.Start a regimen of antibiotics which includes coverage against Gram positive, Gram negative, aenerobes, go for higher antibiotics like IV Piprracillin 4 g with 500 mg of Tazobactum BD, IV Amikacyn 500 mg BD, or Netromycin 200 mg IV BD along with IV Metogyl TID, or Infusion of Ornidazole BD, add on therapy like Tab Paracetamol, Trypsin, Chymotrypsin, Foot end elevation. Send pus for C/S, Follow accordingly, this needs utmosr care, lot of patience to save the limb, still than, against all these efforts we fail to salvage the limb, go for A /K amputation or B/K amputation to save the life of the patient. The outcome totally depends on three things, meticulous control of glycemia with basal bolus insulin, wound debridement, selection of antibiotics.All the best Dr Gopi Chellan, and Congratulations for accepting a challenging case, I have done Several cases like this meticulously, the outcomes were extremely good though these cases test our patience.

Dr Mahendran, thank you very much for accepting the things in a positive way, because I have at least 20 yrs of experience in doing diabetic foot surgeries including amputations too, if we are methodical in approach we get very positive results, diabetic foot is always a challenging issue for all those who deal with the cases regularly, thanks a lot for your positive approach once again.

Cellulitis Conroll dm with insulin Lacal dressing with mgso4 gauz Culture ssensitivity of Swab from wound Antibiotic according test more beneficial T enzohral for inflammation n oedema Take advice from surgeon n endocrinologist if not responding

Agree with dr barve cellulitis with abcess iv anticbiotics higher like pipzo or meropenm linazolid proper control of diabetes by insulin fallowed by multiple incision after coverage of antibotics for 1 tto 2days

Thanks my dear Elayaraja, well sais, my concentration was only on the issue, still then I asked to r/o systemic diseases as there is swelling in the Rt leg too.

Ravindra to tell you honestly, so far in my 25 yrs of cinical experience I have no experience with VAC dressings, hence no comment on this, thanks a lot for the good suggestion, I try it and share my experience.

Cellulitis caused by gram negative organisms highly spreading in nature. It should be treated with broad spectrum antibiotics with adequate drainage with slough excision frequent dressing ect.

Diagnosis-cellulitis. Management-Iv antibiotics and good sugar control...

Thx dr krishna we update so many things by your sharings as diabetic foot is a frequent case to be treated by general surgeons

thank you drkrishna mohan sir for your valuable guidance. with your permission I want to add few things sir.1.to check peripheral arteries pulse (mimimum palpatory method)2.venous doppler must .3 . always I add tab.hetrazan in all unilateral cellulitis.

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