A 58 year old patient with a history of diabetes comes with a history of a lesion that started a month ago. She was prescribed Ciprofloxacin and Clindamycin which she has been taking for almost 10 days. On exam she has no pulse palpable on her foot and a lesion with full smelling discharge

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Advice Doppler x ray and hba1c. Amputation of second toe and debridement under basal bolous insulin therapy and iv antibiotic therpy. Patient is kept under observation

Uncontrolled DM with PVD & gangrene of Rt 2nd toe. Investigations required :- FBS, PPBS, HbA1c, Urea, Creatinine, Micral, Lipid Profile, Urinalysis, CBC, ECG, LFT, Funduscopy, Vascular doppler, X-ray Rt foot AP & Lateral. Needs urgent Ray Amputation of Rt 2nd toe upto Tarso-metatarsal joint. Definitely Insulin should be started with basal bolus regimen, but not strict BSL control as it may cause further ischemia. IV Ertapenem 1gm OD. Daily dressing of wound with NS irrigation. On healing of wound, proper footwear & foot care with diabetes check up at regular intervals as advised by Diabetologist is a must. These patients are prone to recurrent foot ulcers.

Agree with Dr Prakasam.

Thank you sir
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Diabetic foot ulcer Atherosclerosis and neuropathy

Gangrenous second toe with cellulitis .arterial Doppler Amputation of second toe n debridement Strict Blood sugar control

UNCONTROLLED DIABETES.. VASCULONEROPATHY.. GANGRENE RT SECOND TOE.. NEEDS CLINICOPATHOLOGICAL EVALUATION.. BLOOD CBC BS..F..& PM Hba1c.. URINE ROUTINE.. COLOUR DOPLER STUDY .. EXPERTS OPINION..

Thanks a lot sir Dr Partha Sarathi Sahana
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Gangrene in 2nd digit due to uncontrolled diabetic Treatment- Disarticulation of 2nd digit is needed...

Needs an arterial doppler and an amputation of the second toe with Debridement of the Dorsum. If PVD is present please get a vascular surgeon's opinion on the benefits of revascularization.

Ischemic changes in finger of toe Due to Diabetes. Diabetes also affects the flow of blood causes Peripheral vascular disease. If you have an infection that will not heal because of poor blood flow, you are at risk for developing ulcers or gangrene. Color doppler to rule out vascularity of foot.  antiplatelet agents, anticoagulants, and "clot-busters" (thrombolytics) to dissolve clot if present to restore blood supply of foot.

Gangrenous 2nd digit with involvement of metatarsal...inj. piperacillin tazo..but needs amputation asap

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