Concluded Case

Peripheral vascular disease

49 male,chronic smoker,no comorbidities H/o amputation of little finger in opposite limb 1 year back(2020),ulcer(limb in pic) for 6-7 months Doppler (dec,2020)-small and medium vessel involvement,corkscrew pattern-s/o burgers disease.hb-8gm/FL CT angiogram recently done-report in picture.. X-ray-no osteomyelitis Treating with eusol bath daily,multivitamin,zinc,high protein diet,aspirin,antibiotics(based on c/s),clopidogrel,cilostazole,iron tablets.. Any further intervention except above knee amputation..??want to discuss and kindly put your valuable opinion!!

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Is the patient having pain..because even if u keep the limb then the pain factor will be there. If there is lityle or no pain only then limb salvage can be attempted. After few dressings with silver colloids or eusol , the wound may be skin grafted as there is no significant exposure of tendons or bone. As i see sole is intact we can try for limb salvage. If not amputation as an option is always there. CT angio photographs would help more in determining the vascular arcades distally. Rest the medications (vasodilators ) are prescribed aptly.

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NEED'S .. VASCULAR SURGEONS .. AND .. PLASTIC SURGEON'S .. OPINION .. FOR FURTHER MANAGEMENT ..

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Vascular Stasis with necrosis & loss of soft tissues & skin ? Reynaud's disease? ASD locally daily with Betadine ointment, To stop smoking, Blood sugar, Consult Vascular Surgeon for any surgical intervention, Peripheral Vasodilators eg.Complamina/ Trental 400 etc, Left limb shud be elevated. Later Plastic surgery after healing & granulation tissue, Care for secondary bacterial infection. Atlast Amputation is the only way.

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Is the patient having pain..because even if u keep the limb then the pain factor will be there. If there is lityle or no pain only then limb salvage can be attempted. After few dressings with silver colloids or eusol , the wound may be skin grafted as there is no significant exposure of tendons or bone. As i see sole is intact we can try for limb salvage. If not amputation as an option is always there. CT angio photographs would help more in determining the vascular arcades distally. Rest the medications (vasodilators ) are prescribed aptly.

Sir he has very little pain at present,while dressing and debrident he feels the pain,but debridement cant be done nicely as tissues are adherent,no fragile slough actually.. Ct angiography already in the pic sir. Sir can u tell me how will u fo skin grafting,donor site and post op details,thanks
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Vascular surgeon s opinion. If medical management doesn't work, may require BK amputation.

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Tab Coplamina retard 2 B D

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? Pseudomonas ł angiography preserve the tendons h2o2 eosol

NICELY DISCUSSED. IN. DETAILS. .

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Amelioration to stop smoking... ginger lime juice orange juice alkaline organic nutritious diet no stress cold pressed coconut oil massage and in naval.. epsom salt bath... sulpha if tolerant... purple cabbage cabbage juice cauliflower broccoli....til jeera sproutskalijeeri no sugar no nonveg diet no eggs no mushrooms no fried foods no processed or fermented foods and beverages no vyasan pomegranat e muskmelon walnuts blue berries sunshine... Prayers.. under strict supervision of Doctor

Wound debridement , VAC dressing, any intervention to increase peripheral blood flow if possible, followed by skin grafting once there is healthy granulation tissue.

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REFER TO GENERAL SURGEON FOR BETTER DIAGNOSIS

Diseases Related to Discussion

Iron
Osteomyelitis