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Dear Durai Raj, This seems to be a case of Large Neuropathic Ulcer OR May be a sun burn ulcer walking barefoot, may be in hot summer in a temple which is common in our scenario. R/O Diabetes first. Wound seems to be healthy with red granulation tissue. Edges are not healthy. Investigate for FPG 2 hr PG HbA1c RFT Management. 1) Meticulous control of DM with Basal Bolus insulin 2) Absolute bed rest 3) Trimming of edges meticulously until they bleed fresh 4) Appropriate Antibiotics 5) Proper offloading 6) Hyperbaric oxygen 7) VAC Dressings 8) Split skin Graft by a Plastic surgeon. 9) Proper foot care 10) Proper foot ware. Thanks again.

Thank you Sir. What I missed Sir?

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This may be a case of wound due to burn because of walk bare foot on tar road or may be diabetic foot ulcer. Looks like healing wound. Edges must be cut for better healing. Washing of wound with NS Use of topical antibiotics like mupirocin or fusidic acid with daily or alternate dressing. Use of systemic antibiotics like amoxi clav or cefuroxime clav as per body weight. Immunomodilators Multivitamins od If diabetic tight sugar control with insulins for better and faster out come . X ray to look for osteomyelitis Appropriate specially designed footwares to decrease load on wound which will lead to fast healing

What about neuskin....

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daily wound debridement with betadine lotion periphery must be trimmed ,apply mucipirocin oint n on healthy granulation part Jatyadi taila dressing help ..sorry I have to use integrated system here this is my personal opinion

tropical ulcer.

D/D Diabetic ulcer with poor glycemic control Neurotropic ulcer If its painful its may be of arterial origin If its non painful may be its venous ulcer.. Rule out peripheral vascular disease and if burnt ulcer rule out maintaining cause.. Seen in some Leprosy patients... must be rule out.. Dressing must be done daily with Ns and betadine or oxum... unhealthy died margins must be cut off.. If diabetic..strict glycemic control and wound hygiene must be maintained... and obviously broad spectrum antibiotics and anti inflammatory analgesics...

Evaluation for Leprosy. Metronidazole wash, saline dressing, MCR chappals

diabetic foot with ulcerative so first control the diabetes and regular dressing nd wash wd saline nd sterlized nd give antibiotics I/v daily it's recover in one month if regular hygienic dressing nd antibiotics used

large neuropathic trophic ulcer. exclude DM. Hansen's disease. any spinal deformity.

regular wound debridement+ dressing with oxum, gives good result.

Chronic non healing ulcer Requires debridrment of margin which looks unhealthy Looks for vascularity of leg CBC ,Blood sugar Regular dressing with wokadine

this is a classical neuropathic ulcer located on the head of the metatarsal and with a hyperkeratotic callus surrounding it. look for causes of anesthesia like hansens disease diabetes and peripheral neuropathy also look for osteomyelitis in underlying metatarsal head by xray or ct which is common in such cases management care of anaesthetic foot removal of pressure removal of callus by debridement antibiotics including anaerobic cover ulcer healing promoters like topical zinc oxide and platelet rich fibrin matrix skin grafts will not easily take on sole on anaesthetic foot a cellular suspension may be used for healing promotion skin equivalents like appligraf have been usrd in

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