64 yr old male past rand fap necrosis suggestions please



Biopsy from margins of lesion to R/O Residual/recurrence of disease. Debrediment under antibiotic cover till healthy bleeding margins. SSG if only small defect or else DP flap for coverage of gap.

It seems that the wound margin stands out in a distinct fashion - the flap was completely rejected probably due to some immunological cause. The wound floor is still unhealthy. Granulation tissue formation is of utmost importance. For these reasons meticulous surgical debridement and dressings are required. The slough is to undergo culture for all probable microorganisms. Histopathology of pieces from the margin may be of help. Early skin grafting along epithelialisation promoting substance will be much beneficial to the patient. Thank you all.

It looks post radiation neurosis of superficial part of Flap, mostly it looks PMMC. Any pedical Flap is doubtful to reach. Free ALT is better choice. I know Dr Jojo. He doesn't require simple advise about how to dress and STG. He is genius surgeon and Onco surgeon.

Exactly my words sir. Post radiotherapy flap necrosis, needs a flap cover only. Free ALT flap or Free Radial art forearm flap are few options for cover of this critical area. A skin graft seems unsuitable for this area and wound. And of course sir will r/o marginal disease b4 reconstruction.

After debridement when the wound is red and granulating SSG can be done. Alternatively a deltoid pectoral pedicle graft can be moved .

Adequate debridement till fresh bleeding fallowed by pmmc flap tension free repair treat any residual disease and infection in wound before flap by culture and histopathology

Alternative day debridement, will decide after final debridement regarding ssg or flap cover. After each debridement culture and sensitivity should be sent and follow antibiotics accordingly.

Respected Doctor 1. The size of the wound and extent has reached up-to mamsa dhatu. It requires medicated oil medicated with Neem and few more similar drugs known as beans shodhan Taila.This helps I. Nurturing deep seated lesion. 3.Tablet Asheagamdha(known as Indian Ginseng) should be Given 2 GM Thrice a day preferabally with milk. In healthy granulation wound Jatyadi Taila or Lead-in taila can be applied by soaking muslin cloth or gauze piece and covering the wound with it for longer period. Leech application from Ayurveda experts can improve blood supply and improve circulation. Terminali arjuna is wonderful bark drug for non healing ulcers.On infected part or healthy wound it can be dusted by mixing talc powder in equal quantity No Need for any dressing over it. Please feel free to ask any queries. 2.

I agree with Dr T Roy

Whether area received radiation? Linear or Cobalt?

PHOSPHORUS 3--3hrly . After PHOSPHORUS SILICEA 6---4 hrly If.necessary .

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