60 year old male presented with non healing ulcer since last 3 Year’s associate with itching with inflammation and pus discharge. Pedal edema since last 3 months. No History of fever and it’s an painless No H/o DM, HTN Personal History no smoking are using tobacco in any format On detailed examination It is case of Vericoseveins wits stasis Eczema And venous ulcer..... Laboratory investigation are normal Treatment Debridement done under aseptic environment. Tab Amoxicillin +Clavlonic acid started for 7 days Tab Moxifloxacin 400mg for 7 days Tab Acyclofenac and seratopeptidase started for 7 days Advices for alternative day dressing with bactigrass sheets started I requested all doctors for there valuable advice thanks



A case of varicose ulcer . Get a wedge biopsy from the ulcer to rule out malignancy, tuberculosis., syphilis. A colour Doppler study of lower limb vessels to rule out peripheral vascular disease and the extent of varicose veins. Unless varicose veins are not treated, ulcer will not heal First and foremost thing is to to definitive treatment of varicose veins. It can be either surgery Or a newer technique endovascular laser ablation of varicose veins. Once varicose veins are treated, ulcer will heal after following treatment. Adequate debridement required till healthy and red viable granulation tissue appears. Antibiotics - Tab linezolid 600 mg B.D for 2 weeks. Elevation of limb . Once ulcer shows signs of recovery, a SSG is the best possible option

Thanks sir

For now please do regular cleaning and dressings. Try debridase oint for dressings. Followed by foot elevation and soft compression. Once the cellulitis has settled, the varicose veins can be operated upon, after ruling out DVT. Followed by SSG either in the same sitting or a little later

It's a chronic venous ulcer in the gaiters zone .Bisgard s regime is followed for the management of such ulcers.. Along with the management of ulcer ,vericose veins should also be managed.debridement of necrotic tissue and regular dressing with chlorine water should be done . effective limb elevation and crepe bandage should be applied in distal to proximal direction to prevent the venous stasis.later on SSG should be planned to cover the wound.

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Pain less ulcer,is the pt.diabetic has peripheral neuropathy,or must do a culture and sensitivity and use the appropriate antibiotics. Clean it with betadine, send tissue for biopsy and report to exclude malignancy. Once infection cleared obtained healthy granulation tissue go for skin graft,once malignancy excluded. Otherwise you can him till dooms day . One more bold unorthodox step one can take if the doctor. and pt both agreeable is to dress the ulcer by preparing a paste of raw papYa pulp and it will give a very healthy granulation tissue in no time. One can't do any harm by one application.

Ok sir

Good case doctor Thank you for sharing And more informative. My impression is SKIN GRAFT will get good respond for this case apart form above procedures.

Mild antihistamine,compressor bandaging,leg should be elevated on rest, collagen dusting powder with metrogyl ointment topical dressing alternate days,ora linezolid 600mg bd for 10days,pentoxyphylline 1200mg/day... if not u can go for cosmetical inj prp

Thanks sir

Varicose ulcers .....need colour doppler of both legs...den decide treatment

Elevate Compression dressing Dressing with 3% NS SSG After settling Ligations of incompetent perforators

Wash wound with hydrogen peroxide and saline and then sprinkle enzomac-cm powder and then do dressing applying bactigrass sachet and give tab Stiloz 100mg bid alongwith antibiotics you are giving and give additional zinc and protein powder orally .When pus discharge subside in few weeks and red granulation tissue appears,do skin grafting

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