Concluded Case

GANGRENE RIGHT FOOT

A 63 years, patient, complaining with gangrene on right foot č extensive atherosclerotic right femoral artery. O/E BP 130/ 100mmHg Pulse 110bpm chest B/L clear abdo. soft suggest better management..

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Concluded answer
Gangrene of the 3rd and 4th toes due to less blood flow to the lower limb due extensive atherosclerotic changes of the femoral artery Treatment A. Medicine which improve the blood flow like Cilostazol 100 mg bd Amputation of the toes B. Thrombolysis but as this is chronic process so thrombus or atherosclerotic flakes must very much adherent to the wall of the atery thrombolysis complete will be difficult. Inthis case after 1 month thrombolysis a follow colour Doppler to be done to asses the blood flow if not satisfactory then surgical procedure Stenting Or bye pass by saphenous graft.
All Answers
Gangrene of the 3rd and 4th toes due to less blood flow to the lower limb due extensive atherosclerotic changes of the femoral artery Treatment A. Medicine which improve the blood flow like Cilostazol 100 mg bd Amputation of the toes B. Thrombolysis but as this is chronic process so thrombus or atherosclerotic flakes must very much adherent to the wall of the atery thrombolysis complete will be difficult. Inthis case after 1 month thrombolysis a follow colour Doppler to be done to asses the blood flow if not satisfactory then surgical procedure Stenting Or bye pass by saphenous graft.
As gangrene is part of ischemic peripheral vascular disease due to extensive femoral artery atherosclerosis with diminished blood flow to lower limb .. Amputation is indicated Control of B.P Tab Cilostazol 100 mg B.D . Endovascular catheter assisted thrombolysis is indicated. A follow up colour doppler study of lower limb to be done after 1 month. If blood flow is not improved - surgical option can be considered
Thromboembolic gangrene . 1) Aterosclerotic occlusive arterial disease . 2) Infective endocarditis with septic embolism If patient had been more cooperative, aortogram and stenting could have been attempted. Blood culture, antibiotics, anti coagulation and limited amputation could have been tried . But prognosis poor .
Thank you, Doctor
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Peripheral vascular disease adv CTA lower limb also.If patient is tobacco chewing/smoker then avoid for it Diabetic or not?? Patient is anaemic so BT is indicated Amputation is indicated for 3rd and 4th toe. Adv Tab.Pletoz 100 BD Cap.Ecosprin AV OD Tab.Acitrom 2 mg OD Tab.Linezolid 600mg TDS Multivitamin
Consented amputation of these 3 and 4th digit. With blood thinners. And patient require urgent CTVS consultation for the changes in RT femoral artery otherwise gangrene will increase.
Look like wet gangrene with cellulitis Standard line of management

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