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What might be the diagnosis and treatment?

A patient of 80 years old non-diabetic and smoker had a wound on right lower limb,no history of Hypertension . What might be the diagnosis and treatment.

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It is nothing but a case of necrotising fasciatis which requires urgent attention to take the necessary action otherwise pt may lead to systemic septaecimia a life threatening emergency IV drip to continue for nutrition and and to prevent shock. Inj Ceftriaxone 1 gm + Salbactum 500 mg iv bd Inj Metrogyl 100mg iv tds Proper extensive debribement till the normal viable tissue is seen Color doffler to see the vascularity of the limb Blood sugar to rule out diabetes Blood for LFT and kidney function Fresh blood transfusion may be given Maitain intake out put chart Regular dressing and intermittent debribement till the wound becomes healthy and granulation tissue for skin grafting if needed

NECROTISING FASCITIS. It is an acute emergency. Start with Parenteral antibiotics preferably Piperacillin 4gm +Tazobactum 500 mg × 6 hourly and inj Amikacin 500 mg B.D Get a colour doppler study of lower limb vessels to look for any peripheral vascular disease. Shift the patient to O.T Adequate debridement is indicated as much as possible till red and healthy viable granulation tissue appears to prevent septicaemia. After few days once wound is healthy and healing with appropriate antibiotics -a split skin grafting or a pedicle grafting is indicated

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Dd. Venous ulcer Buerger s disease Erythema induratum Necrobiosis lipoidia diabeticorum.... re investigate for DM

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necrotising fasiatis cellulitis venous ulcer to be evaluated send for venous Doppler regular dressing

Necrotic debris Need debridment ,eusol dressing, and antibiotics

Atherosclerotic skin gangrene. Conservative with no smoking.

Chronic infected ulcer

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