Patient 46 year old male came with this... pain * 1 month Pus discharge * 1 month Ulcer over lower leg * 1 month Rx?

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Consider Necrotising facitis The leg can be skin grafted. The foot and ankle beyond salvage.

Necrotizing fascists treat earliest prognosis poor later on it is medical emergency
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Strict control DM. HTN or Dislipidemia if present. History about smoking. Quit smoking if patient is smoker. Past H/O Of any surgery. Pathological evaluation. FBS Hb1Ac CBC Urin RM L. P. K. F. T. K. F. T. HbsAg HIV Color doppler venous and Arterial to rule out thrombosis or obstruction. CT angiography. CT angiography. Treatment Angioplasty. Debridement. Control DM. Pus culture to rule out organism and antibiotics according to the pus culture. Skin graft After healing.

Routine investigations If KFT is normal go ahead with CT angio which will tell u the extent of vessels n any osteomyelitis Debridement under combined spinal and epidural Keep the epidural for post of pain management n analgesia during dressing Wound swab n antibiotics accordingly Please give him a posterior slab or he will not b able to walk again Once the wound is ready then u can go ahead with cover ( either graft or flap)

Agressive debridement is required .Hospitalise for better treatment .If DM should be controlled .

Extensive debridement ,wound culture & sensitivity,dressing with megaheal ointment,SSG /FLAP after healing.

Xray CT Arteriogram hb1ac pt looks bad admit vascular & plastic surgeon

Aggressive debridement is required.must be hospitalised for treatment.if he have diabetes must control it with insulin.

It may require amputation upto the ankle.i think it is going into a stage of wet gangrene..agressive debridement along with long course of antibiotics after culture and sensitivity report...patient is definitely a smoker and diabetic I hope.so strict control over the parameters..

Patient needs split skin grafting after controlling infection and other comorbid conditions.

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