Concluded Case

Non - healing dog bite lesion

52 years,male - a known case of T2DM with history of dog bite at the shown site on dostum of foot since 1 month. The wound has not healed yet- although glycemic control is good Opinion regarding the case

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Concluded answer
Old dog bite dorsum of foot hope pt has completed the full course of Inj ARV. Wound covered with crust and dead skin and there may be pus collection deep to the dead skin Debribement of the dead skin with unhealthy tissues and regular dressing Pus for culture and sensitivity test for proper antibiotic. Strict control of diabetes
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As diabetic ulcers are known to heal slowly and delayed due to peripheral vasculopathy Here cause of ulcer is dog bite but pathophysiology remains same hence despite of good glycemic control delayed healing Debridement excision of necrosed tissue and dress with and wash with h2o2 and NS As granulation is healthy than ssg Rest supportive antibiotics
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1. Debridement of the wound. 2. EUSOL Dressing every 3rd Day total 5 dressings 3. Medicine - Tab - Chymotripsin + Tripsin BID for 10 days Tab - Aceclo 100 + para 325 + serrasiopeptidase 15mg BID for 10 Days Tab- antaacid BID for 10 days Tab - Amoxyclav + Dicloxaciline BID for 12 days Tab - Cefixime OD for 15 days 4. Control Diabetes strictly
Debridement of the wound should be done thoroughly. Avoid applications of Povidone Iodine lotion or ointment inside the wound as it delays the healing of DFUs. Rather you can use superoxide solution (Oxum) spray on the wound & Mupirocin Oint. Oral antibiotics along with good glycemic control & daily dressing of wound with NS irrigation.
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Old dog bite dorsum of foot hope pt has completed the full course of Inj ARV. Wound covered with crust and dead skin and there may be pus collection deep to the dead skin Debribement of the dead skin with unhealthy tissues and regular dressing Pus for culture and sensitivity test for proper antibiotic. Strict control of diabetes
Thank you doctor
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IT'S A..CASE OF.. DM..WITH H/O..DOG BITES..LEADING TO FORMATION OF ULCER.. ? DIABETIC FOOT.. ? DIABETIC ULCER .. NEED'S.. * STRICT GLYCEMIC CONTROL WITH ANTIDIABETIC MANAGEMENT WITH EXPERTS OPINION.. * WOUND MANAGEMENT WITH SURGEONS OPINION.. * ANTIBIOTICS WITH NSAIDS AS PER REQUIREMENT.. * INVESTIGATIONS..
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The lot of oedema surrounding the wound This indicates - it is still in expanding phase, Adv Strict control of diabetes with insulin - use of insulin is very important, Limb elevation Debridement Ecosprin, Cilostazole Appropriate Antibiotic according to culture and sensitivity
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Probably ischemic limb due to DM Debridement, dressing, antibiotics, ARV . Arterial doppler to check for vascularity Rest ,limb elevation
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Diabetic ulcer strict control of diabetes EUSOL dressings for one week then TBact oint locally antibiotics orally nsaid orally
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Wound excision Wait for granulation tissue to cover the wound Skin grafting when ready One line of approach
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