52y/ F, k/c/o= htn, having complain of itching,.. fever, . taken 2 months treatment but condition going worse... plz dx and tx

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52 yrs hypertensive female There are two ulcers, one on dorsum of right foot and other on ventral surface of right lower leg Base showing granulation tissue which is pink in colour There is dark pigmentation of surrounding skin There is no Slough or purulent discharge Lower leg ulcer shows slanting edge suggestive of healing phase Advise Kindly check for diabetes, some times blood sugars can be borderline and HbA1c is raised suggestive of diabetic status, please check on HbA1c, of found to be diabetic - treat it Dark pigmentation is suggestive of venous insufficiency Therefore it can be labelled as 'Venous ulcer' Please do venous Doppler to confirm perforator incompetence Give limb elevation, grade one below knee stockinette, which will give 18 - 20 mm of Hg pressure at ankle, it is the key of treating venous ulcer. It will result in rapid healing of ulcer.

Venous ulcer. R/O Diabetic ulcer. Colour Doppler study of vascular system of both LL. BSL,RFT,LFT,Pus or tissue for CS. CBC,ESR. Leg should be raised up atleast half an hour 3-4 times daily. Tab Cefuroxim Lenezolid (500+600mg) BD×7days. Tab Serratiopeptadase 15mg BD×7days.. Multivitamin & Antioxidant. Tab Pentoxifylin 400mg BD. Tab Diosmin 300mg TDS. Wash wound with NS Betadine Soln. Debridement of unhealthy granulation tissue. ASD with Megaheal ointment. Use sofratuli. Prevent trauma. Personal hygiene to maintain. May switch over to specific antibiotics after getting reports. If not improved,refer to Plastic Surgeon.

Thanks Dr Shital Jadhav
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? Venous ulcer Debridement and dressing with mupriocin oint after pouring H2O2 and saline thoroughlyand gently clean area with diluted betadin lotion. Inj ceftum 1gm IV slowly BD. Pcm+ibu TDS Levocet HS. Multi vitamins and antioxidants orally. ASD with sofra tullu gauge daily. Needs further investigations and evaluation to conclude diagnosis and line of treatment. Raised limb .

Thanks Dr Kute Ankush.
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Two ischaemic ulcers on foot. Get a colour doppler study of lower limb vessels to rule out vascular insufficiency. If present tab cilostazol 100 mg B.D for 2- 3 months will improve blood supply and help in healing of ulcer . Also rule out DM and if present glycemic control to be achieved. Wounds look healthy, A little debridement. Antibiotics. Dressings are required before split skin grafting is definitely required with no other option

*ULCERS ON FOOT.. ? TRAUMATIC..OR..PATHOLOGIC.. *WOUND LOOKS GOOD..ONLY THE CORRECT PLANING & MANAGEMENT REQUIRED.. *NEEDS CLINICOPATHOLOGICAL EVALUATION.. *BLOOD CBC CT BT PR *URINE ROUTINE.. *C & S TEST.. *BSR ,Hba1c.. *COLOUR DOPLER STUDY.. *MEANWHILE TREAT WITH.. APPROPRIATE ANTIBIOTICS WITH NSAID & MULTIVITAMINS .. *LIMB ELEVATION..& TOPICALLY ANTISEPTIC ANTIBIOTICS OINTMENT.. *REST.. *PROCEED AS PER REPORTS WITH EXPERTS OPINION.. *PLAN FOR SKIN GRAFTING.. *IN DELAYED WOUND HEALING LLLT LASER TREATMENT USEFUL AND BEST OPTION TO THINK..

Tnx a lot Dr Shital Jadhav
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Please advise for Culture & Sensitivity of the Pus at the Wound Site Sir.. Then check for Blood Sugar Levels of the Patient.. Rx Twice Daily dressing with Hydrogen peroxide, Betadine, & Normal Saline Packing the wound with either MEGAHEAL Ointment or PLACENTREX Ointment.. Inj. TAXIM 1gm IV BD for 5-7days Inj. METROGYL 100ml IV TID for 5-7days Tab. ACRIMOL SP BD for 5-7days Tab. LIMCEE TID for 5-7days Tab. LEVOVIB BD for 3-5days

There are two ulcers. One on the Dorset of right foot and other on the ventral surface of right lower leg.

@ Echthyma gangrenosum...High protein diet + if no discharge SSG .the option

Lupus vulgaris, exclude diabetes, hiv

Check out Her Blood Sugar Values CBP Culture & Sensitivity test of the Pus from the Wound Site Liver Profile Urine-Albumin, Sugar & Microscopy..

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