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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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.

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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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.

This case of diabetic foot requires a thorough debridement. good control of DM, antibiotics and rest. After wound healing proper foot wear and councelling about foot care.

Diabetic foot with gangrene second toe Amputation debridement Dressing SSG

Gangrene in 2nd digit due to uncontrolled diabetic Treatment- Disarticulation of 2nd digit is needed...

It's diabetic wound.. Leading to gangrene.. Sir specialy for such wound I have prepared a unique formulation which is very good working.. I have treated such cases, no need of debridement or amputation.. .. If you want it.. Plz feel free to contact me on - 7744059110 this no...

Go for arterial and venous dropler test....then amputation of 2 nd finger.... manage sugar level with insulin...keep wound hygiene...

Diabetic foot ulcer turning into gangrenous ulcer

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