Does anyone have any suggestions for this vascular wound? We have tried Santyl, anasept gel and tender wet? The vascular doctor recommends amputation but family declines.

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Improve the blood supply to limb with Pentoxifylline 400 mg T.D.S. Debridement required till healthy viable and red granulation tissue appears followed by dressings with betadine lotion cleaning and megaheal gel. Parenteral antibiotics Piperacillin 4gms + Tazobactum 500 mg BD for 7 days followed by oral antibiotics. A relook debridement after 5days. If there are signs of wound getting better a skin grafting may be required

Sir Pentoxifylline can be used routinely for all lower limb ulcers with Slough??

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What is required is a good debridement, diabetes control if present, antibiotics, investigations to rule out the cause, since u have said vascular wound, I presume it is venous ulcer.. get a colour Doppler to confirm.. if venous insufficiency, requires 4 layered bandaging, elevation, and if no DVT, Trendelenburg surgery will help... Finally when wounds are healthy, they can be grafted.. I think it's salvageable... VAC can be applied on to wound after debridement..

This time it requires debridement along with diabetes work up and controll. If distally the limb gets gangrenous and blackened then amputation is preferable with proper consent to him and his attendants.

Excise the slough . Repeated sterile dressings of both wounds untill clesn granulations appear. With plastic surgeon help do a vascular cross legged pedicle graft reconstruction . Doplar us . Both legs for vedsels. Antobiotics.. correct aneamia.deficiencies of proteims etc.

Debridement of all the ulcers till bleeding, with freshening of the margins needs to be done. Send the tissue for culture sensitivity. Start appropriate antibiotics. Negative pressure wound therapy postoperatively. Access vascularity of the limb by means of colour doppler. Review ulcers after 4 days and proceed accordingly.

What's the cause of ulcer?? For in picture ulcer margins are looks like sloping or undermined (, ulcer edge close photo).rule out tuberculosis. Wht and why vascular surgeon advices amputation? Whts his clinical diagnosis? Colour Doppler reports., Pts age, sex, smoking habits, associated co morbidities, peripheral pulsations, etc please look and send. I feel in all its s curable ulcer....... Many modern and traditional ABCs modalities can be used.

Y amputation. Clinically 1st check the pulsations of periphery ,Ant tibial post tibial and dorsalis pedis. Duplex scan. Remove the etiological factors like smoking. Tab Stiloz can b given .with pentoxy. Improve oxygenation. Debridement till active bleeding with punctate bleeders. Then dailu dressing . Grafting after granulation tissue.

Looks like diabetic foot.... Go for proper debridement of this wound.... Antibiotics.... Diabetic care & medications..... Proper wound care to be done.....

No need of amputation,, first the white mass daily removed dress it gandhaka taila .antibiotics pain killer. Mult vit od.

Culture and sensitivity of tissue, dressing with bactigra oral antibiotics according to report, biopsy for malignancy.clean the slough. Or try raw papaya paste dressing may cleaner the wound.

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