Concluded Case

TAO of right foot

Non healing ulcer of right foot great toe more than one month, associated with gait disturbance History Smoker and alcoholic Investigations Colour Doppler ultrasound scan showed SFA 90%blockage and as well as ATA and PTA also Management Given cilostozole 100mg twice in a day and other supporting medicines

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Concluded answer

Gangrene of rt great toe Raynods disease of smoker Opinion of vascular surgeon To remove clot with amputation of rt toe Feel pulsation pedal Continue cilostozole 100 bd

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Gangrenous great toe Secondary to peripheral vasculopathy as a result of DVT Needs inj clexan 0.4ug bd for 10days with monitoring of pt inr and ptt Continue tab celistazole 100mg bd Daflon 1000mg tds Debridement of wound under block anaesthesia and irrigation with h2o2 and NS dress with bactigrass If healing seen than good otherwise Amputation gr toe is advisable to save foot Rest of supportive treatment with broadspectrum antibiotics And antiinflamatory

Thanx dr Ashok Leel
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? VASCULOPATHY .. ? GANGRENE .. NEED'S .. CLEANING DEBRIDEMENT AND DRESSING WITH MUPIROCIN .. SURGICAL INTERVENTION .. AMPUTATION .. WITH .. SURGEONS OPINION ..

Tnx Dr Shivraj Agarwal sir
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Antibiotics orally and topically x 5 days. If not improved not to wait for any other alternate except Amputation. Even after that he should have to change his habits and life style otherwise more episodes are waiting..!!

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Most important intervention for thromboangitis obliterance is stopping smoking Other interventions are Cilostazole Ecosprin Atorvastatin Low molecular weight heparin

Gangrene of rt great toe Raynods disease of smoker Opinion of vascular surgeon To remove clot with amputation of rt toe Feel pulsation pedal Continue cilostozole 100 bd

Smoking related Raynoud's disease? Diabetic profile, May need amputation of G.toe as gangrene all ready developed ? Till that ASD locally daily with Betadine oint, Oral Antibiotic, Antiinflamatory, continue Celestazole tab. Foot end shud be elevated, Stop smoking & alcohol, Wt & watch for improvement before amputation decision.

Pre op work up Antibiotics preferably Dalacin C and Cefuroxime Continue Stiloz 50 to 100mg daily Plan for Stenting / bye pass surgery of concerned vessels and amputation of toe

One big glass orange juice with fudina... every morning ....needs counselling calmness symphony music lime juice coriander leaves currypatta lemongrass decoction alkaline diet no sugar no nonveg diet no eggs no mushrooms no fried foods no processed or fermented foods and beverages sprouts kalijeeri green leafy vegetables guava pomegranat es muskmelon chiaseeds soaked overnight methidana soaked overnight alternately sunshine walk prayers ginger figs guavas raisins dates .. beetroot sweet potato corn broccoli cold pressed coconut oil massage and in naval....under strict supervision of Doctor

GANGRENE TOE? NONHEAL ULCER? REQUIREMENT OF ANTIBIOTIC ORALLY.

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