Diabetic pt age 43/F control Diabetes but still wound is not healing ..... suggest me line of treatment.... should I ref for amputation or it should b solve by conservative treatment.....

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Yes it is diabetic foot Looks to be it was cellulitis given way as nonhealing ulcer Dear dr even if diabetic control is there doesnot mean earlier healing since in diabetic foot it is micrvascular complications which affects the healing process with added peripheral neuropathy compounds the situation Hence with proper control it needs frequent debridement and healthy dressings with H2O2 and NS irrigation with insulin infiltration and bactigrass dressings If you see good granulation than you can expact healing will progress otherwise to save the foot decisions of gr toe Amputation may have to be taken so don't loose confidence and continue your efforts with counseling Broadspectrum antibiotics are to be use and you may go for c&s to choose the proper antibiotics

Thanx dr Sri Ramya Waltair
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RULE OUT 1) Underlying occlusive vascular disease due to Diabetes by doing Arterial colour Doppler studies. If there is ischemia this should be treated by vascular surgeon. 2) Underlying OSTEOMYELITIS, if so antibiotics, curetting of bone can be done , to hasten healing of ulcer . Otherwise, treatment is what is already being done, debridement, dressing with sterile dressings, antibiotics, metronidazole, flucanazole ,Tab Celestazole, treatment of neuropathy with B1,B6,B12,, alpha Lipoic acids , and rest . If wound is clean without foul smell, and good granulation is forming , you can continue .If the cellulitis is spreading up, foul smelling discharge is there, consider amputation

Thank you doctor
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IT'S A CASE OF.. DIABETIC FOOT.. NEED'S CLINICOPATHOLOGICAL EVALUATION WITH.. HEMOGRAM.. BSR HBA1C.. URINE ROUTINE.. SWAB C YOU S EXAMINATION.. COLOUR DOPLAR STUDY.. EXPERTS OPINION.. MEANWHILE TREAT WITH.. BETTER PROGNOSIS NEED'S BETTER GLYCEMIC CONTROL WITH ANTIDIABETIC MANAGEMENT.. CLEANING DEBRIDEMENT AND DRESSING WITH MUPIROCIN.. BROAD SPECTRUM ANTIBIOTICS WITH NSAIDS.. MULTIVITAMINS ANTIOXIDANTS.. LIMB ELEVATION.. SURGEONS OPINION FOR FURTHER MANAGEMENT..

Tnx Dr Shivraj Agarwal sir
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I think the black part is gangrenous, as looking in the pic Do one thing Do USG DOPPLER, XRAY OF THE AFFECTED LIMB SEE THE EXTENT OF VASCULAR SUPPLY IF INSUFFICIENT, THEN ONLY AMPUTATION IS THE OPTION LEFT. GLYCEMIC CONTROL APPROPRIATE FOOTWARE REGULAR DRESSING WOUND HYGIENE ANTIBACTERIAL IS ADVISED AS USUAL.

It should be better to control dm first. As the granulation tissue still not healthy, antiseptic dressing , debridement is required , alongwith piperciline and tazobactum ,Mupirocin oint and if not progress then amputation may be required in my opinion

Diabetic foot with deep seated cellulitis. Ad- strict BS control -Debridement f/b culture sensitivity and broad spectrum antibiotics covarge

Diabetic foot

A diabetic foot to diabetic ulcer. It is non healing mainly due to poor blood flow and may be associated osteomyelitis. Get a colour doppler study of lower limb vessels to rule out PVD . Also get an X- ray done . If osteomyelitis give parenteral antibiotics for at least a week followed by oral antibiotics. If PVD - cilostazol 100 mg B.D for 2 months. Debridement as and when required. Doing dressings in such a patient is an art and preferably should be done by an experienced dressser

Yes it is DFI.... Start Colostrum Two @cap Two times and day and sprinkle Two capsule over the wound.. Two times a day for 15 days.... And control Diabetes... Definitely you will get better results...... Try for 15 days....... You will get positive results.... Don't ignore

Do arteiogram studies gives clear picture of arterial supply of foot do debriment of wound in ot xray foot daily dressing with collegen aug625 bd continue wait for amputation necrosis is visible

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