55 year old diabetic lady presented with wound and discharge from right thigh and knee area since 20 days. O/e Pale, vitals stable RBS 180mg/dl L/e: scab with gangrenous tissue Slough with purulent discharge. systemic examination:WNL



Necrotising fasciitis. Achieve strict glycemic control with insulin. Parenteral antibiotics inj Piperacillin 4 gms + tazobactum 500 mg × 6 hourly for 7 followed by oral Linezolid 600 mg B.D. Debridement in OT with removal of dead necrotic tissue till healthy and red viable and healthy granulation tissue appears. A relook debridement may be required after a weeks time . Dressings with betadine lotion cleaning and mega heal gel . Maintain fluid and electrolyte balance Protein, vitamin A , C and Zinc supplements for wound healing. Once progress is good and wound is clean with healthy granulation, SSG may be required

Prevent septicemia

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Necrotising fascilitis. Control DM sritly. Antibiotics injured. Piperacillin 4gms+Tazabactum 500mg IV 6hrly for 7days.

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Necrotizing fascitis Debridement of necrotic tissue for under LA / spinal Wound clean with NS Betadine solution and H2O2 Bectigras dressing alternate day Strictly Diabetic control, Diabetic diet Start insulin IV meropenem IV metro 100ml IV LNL IV pan IV tramadol Limb elevation Multivitamins, Antioxident

Necrotizing fibrofasciitis Should get vigorous treatment under joint hands of a physician for strict glycemic control and a surgeon for debridement with coverage of mrsa effective broad-spectrum antibiotics plus symptomatic

Diabetic gangrene Control diabetes Elevation Dressing Excision of all dead tissue Dressing SSG Compression garments Keep on insulin at least till it heals

•Necrotizing fasciitis, rapidly progressive inflammatory infection of the fascia, with secondary necrosis of the subcutaneous tissues. •Depending upon etiology, 3 types: Type I, or polymicrobial Type II, or group A streptococcal Type III gas gangrene, or clostridial myonecrosis •High risk pts are commonly immunocompromised with diabetes mellitus, cancer, alcoholism, vascular insufficiencies, organ transplants, HIV infection, or neutropenia. •Early diagnosis and referral for aggressive surgical treatment prior to the development of systemic toxic signs are essential. Complications may include the following: Renal failure, Septic shock with cardiovascular collapse, Scarring with cosmetic deformity, Limb loss, Sepsis and Toxic Shock Syndrome. •When the pt is seriously ill, necrotizing fasciitis is a SURGICAL EMERGENCY with high mortality. Therefore, laboratory tests and imaging studies should not delay surgical intervention. •Laboratory evaluation should include the following: CBC with Differential (leucocytosis), Serum chemistry studies(Elevated BUN, reduced Na level) ABG Urinalysis Blood and tissue cultures(Deeper tissue samples, usually obtained at the time of surgical debridement, are needed to obtain proper cultures for microorganisms) •Imaging studies include :USG, CT and MRI. MRI or CT scan delineation of the extent of necrotizing fasciitis may be useful in directing rapid surgical debridement. Rx: •Maintain hemodynamic stability of pt. Maintain BSL. •Empiric antibiotics should be started immediately, usually a combination of penicillin G (Ampicillin+sulbactam)and an aminoglycoside (if renal function permits), as well as clindamycin (to cover streptococci, staphylococci, gram-negative bacilli, and anaerobe). •Early surgical treatment may minimize tissue loss, eliminating the need for amputation of the infected extremity. WIDE AND EXTENSIVE DEBRIDEMENT of all necrotic and poorly perfused tissues is associated with more rapid clinical improvement following dressing with Silver sulfadiazine. Intensive Care can be needed PostOp. Hyperbaric oxygen therapy (HBOT) may be considered, if available. Maintain fluid and electrolyte balance with parenteral nutrition once pt is hemodynamically stable. •A more specifically targeted antibiotic regimen may be begun after the results of initial gram-stained smear, culture, and sensitivities are available. •Soft-tissue reconstruction further...

Control diabetes.clean the wound.do debridment.remove slough. Do Fucidin dressing dressing give cefedrox cap vitamins.b.complex

Treat the Pt as treating acute heart attack. Fluid by vein suitable antibiotics. Debriment of wound in o t. Dressing with suitable antiseptic check blood supply by palpating vessels as supply to part. Control diabetes with inj plain insulin. CO treat with plastic surgeon rest to part. Keep patient in air condition

Necrotising fasciitis Necrosectomy Broad spectrum antibiotics Ivf See renal function Correct anaemia Pus culture R/o diabetes

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