82 years old female with A non healing ulcer since 1 year. which ulcer formation after winter chilblains 1 years back .over heel Although almost 50 % healing had occurred in 1 year . No history of DM , hypertension Colour doppler normal Management and treatment for early healing



Wound debridement & explore the wound, deslough the wound, initially antibiotics ointment & later Co-Mupimet granules to fill the ulcer early. Be careful about keeping the wound moist. Then SSG with offloading to be advised After completely healing of the wound, proper footwear with socks along with foot care to be advised.

If no Co-morbidity factor exists, then possible line of management : Debridement,, specially at margins; send tissue for HPE. Use Recombinant Platelet Derived Growth Factor & Silver impregnated gel for dressing. Nutritious diet & nutritional supplements. I think, the wound should heal in 1 - 1.5 months.

Explore the complete wound and debridement & scoping of wound with deslough till peripheral blood ozing start Bectigras + co_mupiment ointment dressing day If needed start Higher Antibiotics Multivitamins Limb elevation Avoid pressure during walking especially affected area

Sir, Co-Mupimet is granules & Mupimet is ointment

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Trophic / rmalum perforan pedis non healing ulcer Co mupimet granules dressing regularly No doubt it will take time to heal properly Oraly broad spectrum antibiotics Cap becausle/cobadex Pure turmeric 1 tsf od wid milk

Dear Dr.Yograj It needs reconstruction by a local rotstion flap. Prepare the defect and take your plastic surgery colleague's opinion

Thanks, sir

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Debridement and flap cover

Thanks , sir

Wound debridement & explore the wound. Desloughh the wound

Wound debridement Disinfecting the wound around the ulcer Dressing with calcium alginate which inhibit bacterial growth Polyhexamethelene biguanide gel Strictly sterile dressing Rest of the affected part Avoid pressure on affected part

Excision and flap cover

Wound debridment. regular dressing. Higher antibiotic....

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