Concluded Case

DM, plantar abscess .

Here is the plantar abscess in a diabetic foot with anaesthetic sole due to sensory loss and thorn prick induces the infection. Discuss the case. Lady ,49 years,rural woman ,on insulin therapy . Daily dressing is being done at OPD care.

(Edited)

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Concluded answer

Consider following a. X ray of the foot, to rule out osteomyelitis, if present needs to be dealt b. Radical debridement c. NPWT d. Strict glycemic control and sugar charting daily. d. Routine blood investigation e. Doppler study of both lower limb. f. Considering her morbidities, skin grafting can be done to cover the wound. g. Modified PMR footwear to be advised. h. Regular follow and educationon of the patient to avoid any trivial trauma in future. i To do Amputation at this stage, is very early. But yeah if there is recurrent ulceration, patient is not keeping glycemic control and if other morbidities present(cardiac and or renal), patient is not regular on follow up, amputation can be considered later. j. Most important thing remember your patient is diabetic, dnt forget to evaluate cardiac system, renal, and ophthalmology to stage and manage other systemic issues in diabetes.

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Consider following a. X ray of the foot, to rule out osteomyelitis, if present needs to be dealt b. Radical debridement c. NPWT d. Strict glycemic control and sugar charting daily. d. Routine blood investigation e. Doppler study of both lower limb. f. Considering her morbidities, skin grafting can be done to cover the wound. g. Modified PMR footwear to be advised. h. Regular follow and educationon of the patient to avoid any trivial trauma in future. i To do Amputation at this stage, is very early. But yeah if there is recurrent ulceration, patient is not keeping glycemic control and if other morbidities present(cardiac and or renal), patient is not regular on follow up, amputation can be considered later. j. Most important thing remember your patient is diabetic, dnt forget to evaluate cardiac system, renal, and ophthalmology to stage and manage other systemic issues in diabetes.

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Diabetic non healing ulcer admit short acting insulin xray ct angiogram call vascular & plastic surgeon debriment of wound iv antibiotics collegen dressing blood supply has to increase for recovery Pedotrist can play role

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Sir do debridement and remove all sluff tissue apply insulin dressing If avilable after aggressive debridemt apply vacuum assistance closure for 3 weeks followed by skin grafting It will settle

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Focus on blood sugar control Laser therapy for ulcer healing *Plastic surgeon's opinion for further management

This case can be treated without any amputation or surgery thanku gys
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This case can be treated and cure successfully without any amputation or surgery thanku

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Congratulations! Your case has been selected as Case of the day and you have been awarded 5 points for sharing the case. Keep posting your interesting cases, Happy Curofying!

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since sole is asensate, it will recur, also for rural patients, consider below knee amputation

Artificial prosthetic limb is not superior to the real leg.
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