A close relative (53yrs, female, hypertensive, no history of diabetes and tobacco) was admitted in ICU for 15 days due to severe viral pneumonia/ARDS. The pneumonia is now almost cured, but the patient has developed these gangrene like dead cells on her fingers. Most likely cause is a thrombus developed in wrist due to pic line used during pneumonia treatment. The vascular surgeons took a call to not take surgical intervention at that time due to severity of lung damage and started heparin. She is out of ICU for last 1 week, but still getting fever multiple times everyday. All the blood tests for bacterial infections are coming negative. The doctors at the hospital are saying that they will wait for sometime and then probably amputate the affected area. Is there any way to heal this without surgery? Also, could gangrene be cause of fever? Edit: I have attached the image of Doppler report. Also heparin is going on for last 20 days.




Dry gangrene may be Reynould’s phenomenon or extreme hypotension during pneumonia,———Maggot therapy is effective even in modern medicine,Maggots play non surgical method to remove dead tissue.When used to treat gangrene maggot, fly larva specially bread in laboratory so they are sterile are placed over the dead area they consume dead tissue withou harming healthy tissue & speed the healing by releasing substances that kill bacteria

Yes sir. There is leech therapy in unani system of medicine. Apply leech on affect part, it will engulf the gangrenous parts. Natural debridement.

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Amputation will be required.but initially LMWH can be tried for 2- 3 days to hope for reperfusion Since it is symmetrical peripheral gangrene Causes could be Vasculitis Raynaud's disease A colour doppler study of upper limb vessels will be helpful

Amputation will be required but.A initially LMWH can be tried for 2-3 days to hope for reperfusion . A colour Doppler study of upper limb vessels will be helpful.

Thrombotic Thrombocytopenic Purpura. Lupus anticoagulant. DIC Protein c and s etc should be excluded before resorting to amputation. Heparinization to be attempted or surgical thrombectomy .

Reynolds phenomen

Dry gangrene . Amputation will b required . Vascular surgeon opinion will prevail .

It's established Gangrene. Doppler showing Chronic thrombus at bifercation and extending to radial artery. And heparin is going on for last 20 days. Continue heparin, and vasodilator & try injection papaverin if possible. Try stellate ganglion block or brachial plexus block if possible. Urgently Refere to Vascular and Plastic Surgeon if thrombectomy is possible or amputation ?

Secol cor200

When it's very confirmed that due to one or other reason vasculitis/Dry gangrene caused. And amputation is commonly suggested. My suggestion is, when it's to be referred to vascular surgeon later on WHY NOT FROM DAY ONE CASE TO BE REFERED TO VASCULAR SURGEION AND JUST FOLLOW HIM.

This may be a case of wegeners granulomatosis or PAN. She could be having diffuse infiltrates in cxr or ards or diffuse alveolar haemorrhage mimicking pneumonia. Digital gangrene doesn't seem to have alternate pathology if we relate it with her chest condition. Fevers due to acute flare and secondary infections may be there. So, get CBC, ESR, RA factor, CRP levels, ANA and ANCA profile done. If it turns out to be connective tissue disorder, treatment would change altogether and this may be the cause of sterile cultures. Reassess and re-evaluate again.

In such cases Jalokavacharan (Leech Therapy) can prevent the amputation..... Along with modern management if we plan the Jalokavacharan then the prognosis will be great, chances of recovery will he high....

Sympotems are not so good. Seems a rare mistake during tmt Any one blieve or not.Now Ayd. Can save the fingers. I agree with Dr.Nitin Manera ji's Arrangement.Mahaluxmivilas ras or Swaran Basant Malti ras can add with combination fr quick relief. Dr.Manish Malhotra ji req.to use Ayd.in this case.@ @Vijay Attri ji.

Thnks a lot sir g

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It is better to surrender to the best vascular surgeon .

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