A 62ye male pt c/o sever pain & swelling in rt leg , redness in rt leg k/c/o DM/ HTN H/O aresepalas 5yr back in rt leg? diag & Rx?

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This is a case of 1) T2DM 2) HTN 3) Diabetic Foot with Wet gangrene. Investigations. FPG 2hrPG HbA1c RFT Serum Electrolytes ECG Vascular Doppler CT Angiography to know the level of obstruction. X Ray Foot AP & Lateral to r/o Osteomyelitis. Management. Immediate admission and take high risk consent and explain the situation to patient and attendants. 1) Meticulous control of DM with Basal Bolus insulin. 2) Meticulous control of HTN 3) Correction of dehydration 4) Correction of Electrolytes 5) Definitely needs amputation. But before that Surgeon should do meticulous wound debridement with removal of Slough and debris. 6) Look for the demarcating line. 7) Parenteral antibiotics against Gram positive Gram Negative Aenarobes. 8) Plan for Amputation based on the CT Angiogram. 9) Daily wound dressings 10) Proper foot care and foot ware with proper off loading. Counseling of the patient with regards to DM HTN Foot care.

This is wet gangrene due to diabetes. To check bony involvement with x-ray,& c Doppler.if there no bony involvement .. Strict control of DM With Basal bolus insulin, Ahtn,start broadspectrum antibiotics, and multiple incision to made & clean the wound..regular dressing with wound debridement.
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wet gangrene. get a doppler done to document the site of obstruction. start the patient on broad spectrum antibiotics and control diabetes. let the line of demarcation form and then do amputation.

Wet gangrene / diabetic gangrene . first of all shift Pt on insulin. inj Tetvac inj Cetrioxozone + sulbactum 1.5 GM IV BD . inj lincomycin IM BD Tab Ceftum 500 mg BD. Tab Ornidazole BD Tab Chymotrypsin BD aceclofenac Paracetamol saeropeptidase BD Tab Pantaprazole + domperidone OD. Tab Multivitamins OD. Muprison application Wash with Normal saline Betadine application . Doppler report first of all try to save the foot. by extensive therapy . cleaning the wound amputation is last option. always try to save the Pt with limbs.

wet gangrene needs amputation,ct angiography to know level of occlusion and revascularisation for stump healing
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it is diabetic gangrene advice colour Doppler tight sugar control by insulin go for amputation after Doppler report by diabetic surgeon

Cellulitis

It is "Diabetic foot infection" Requires immediate admission and Foot Exploration. During the procedure all the devitalised tissue will be debrided. The debridement will help achieve good sugar control. This needs to be followed by an angiography to see the flow. Depending on the flow in distal vessels decision will be taken regarding the level of amputation.

diabetic foot with gangrene with cellulitis..needs gram positive and neg bacteria to cover and doppler and ct to be done ... removal of slough...dressing and surgeon opinion...

cellulites goes to gangrene. immediate control DM and take under treatment as per condition.

Diabetic gangrene, advised cleaning & debridement, control diabetes, colour Doppler study.

cellulitis of rt leg n dorsum of foot. immediately patient needs fasciotomy...multiple incisions.. derrof n debridement... limb elevation...broad spectrum antibiotics..analgesics.. needs evaluation by colour doppler of rt lower limb. control of blood sugar and blood pressure.. this perticular patient once recovers from this acute phase ..there will be loss of skin sub cut tissue and needs evaluation of plastic surgeon and possible skin graft ..in worst case propellar flap

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