Wound over the leg

A 65 year old female presented with this wound over the leg. He has an uncontrolled diabetic and she is a cardiac compromised obese female. Wound is post debridement for cellulitis. It was operated elsewhere. Dressing with honey showing changes over a period of two weeks. What will you suggest for the treatment?

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First meticulous control of Diabetes by premixed human insulin or basal bolus insulin depending on blood sugars. Advice Doppler of lowerlimbs . Continue cardiovascular drugs. Limb elevation and bed rest advised. Iv antibiotics both gram positive and negative if she is under admission , if not oral antibiotics,depending on serum creatinine. Advice antianerobic drugs Tissue lytics. Wound cleaning and debridement should be done meticulously. Skin grafting may be required for dorsum of foot . Ask her to take plenty of lemon water and oranges for wound healing if her serum creatinine and potassium are normal.

Very very unhealthy tissue..start NS dressing everyday after proper debridement and excision of nonviable tissue ..go for duplex USG..and routine blood investigation and HbA1C report..antibiotic appropriately ..once granulation tissue develops and bed is healthy ..go for STSG . meshed grafting..use NPWT to reduce the wound bed once the bed is free of infection and looks healthy..after coverage NPWT could be used to accelerate the healing ..thank you

Post surgical nonhealing ulcer leg with diabetes As wound appears to be granulating should more time be given to granulate with either you are following the dressings or just irrigate with NS and add placentrax gel for dressing With good granulation consider SSG Keep good control of diabetes Sir my question is Granulation with honey suggest local carbohydrates for local cells improving oxygenation is it true

Thanx dr Sachin Ambure
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Diabetic foot with unhealthy wound over the dorsum and covering the ankle to the posterior aspect. Wound does not show any bleeding scrap the wound regularly so that it bleeds easily to help granulation tissue over the wound Regular dressing till the wound healthy and wel formed granulation tissue and ready for skin graft Strict glycaemic control with injectable firm of insulin

Thanks dr Abdul Majeed.
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Strict control of Diabetes. Assessment of blood circulation,Joint movement, skin condition, Bony involvement or not. Meticulous dressing. Culture and sensitivity of pus- select HS antibiotic. Foot end elevation. Skin grafting- may needed. Proper nutrition. Blood for CBC ESR FBG PPBG check regularly. Vascular surgeon, endocrinologist, Orthopaedician opinion needed.

Diabetic ulcer. Control DM by diet , medicine and change of life style. Regular debridement and dressing with betadine lotion apply sofra tullu gauge daily. Inj ceftam 1gm iv bd slowly. MVI in drip or with inj. Analgesic antiinflammatory orally. Multivitamin and antioxidant orally. Rest part and raised. Further investigation and evaluation required.

Thanks Dr Dinesh Gupta
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Control of sugar levels. Debridement of wound and cleaning and proper dressing regularly. Antibiotic orally. Doppler of legs to know venous circulation.

Take on insulin Wound is ready for skin graft Do it

Diabetic foot following uncontrolled diabetics. Diabetic neuropathy involved. Pyoderma Ganrinosum..an auto immune disorder. Doppler study will give a confirmed conclusion. Glysemic controll is a must.

Post surgical non healing ulcer. Suggest. Control of DM Leg/foot elevation Daily cleaning & dressing. Tab. Clindamycin 300 mg Bd Tab. Topla D. Bd. Tab. Neurokind Gold. Night. Only.

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