CASE STUDY 6
CASE STUDY 6
MR T, 63 YEARS OLD CHINESE, HAWKER STALL OWNER
DM FOR THE PAST 15 YEARS
MRS T DEVELOPED DRY GANGRENE OVER LEFT 4TH TOE, AND UNAWARE OF THE INFECTION FOR 2 WEEKS, SOOK TREATMENT FROM REGULAR PRIVATE CLINIC. 3 DAYS BEFORE PRESENTATION TO OUR CENTER STARTED DEVELOPING SEROPURULENT DISCHARGE AND MALODOUR.
HE IS:
ACTIVE SMOKER, OCCASIONAL ALCOHOL CONSUMPTION
OTHER COMORBIDS – HYPERTENSION, DYSLIPIDEMIA, IHD ON MEDS FROM IRREGULAR GP AND OVER THE COUNTER
ECG: SR, NO ISCHEMIC CHANGES NOTED
NEUROPATHY | +++ |
DPA | Palpable ++ |
PTA | Palpable ++ |
ABPI | 0.8 |
DOPPLER | ++ |
- Of The Affected Limb
GLYCEMIC CONTROL WAS POOR. NUTRITION SCORE WAS MODERATE
NO PRE DIABETIC FOOTWEAR, WITH GOOD FAMILY SUPPORT
DIAGNOSIS: – LEFT DIABETIC FOOT ULCER, WAGNER (ULCER) STAGE 4; PEDIS (INFECTION) GRADE 3.
MR.T UNDERWENT EXTENSIVE DEBRIDEMENT SERIAL TISSUE REPAIR. MID-PLANTAR APPROACH WAS USED. SINUS TRACT WAS EXPLORED, DEBRIDEMENT OF OM BONE AND TENDON REMOVAL WAS DONE. SUBSEQUENT FOLLOW UPS HE WENT THROUGH SERIAL DEBRIDEMENT’S WITH ADVANCE WOUND DRESSING. WOUND HEALING ACHIEVED IN 3 MONTHS.
TILL TODAY MR T IS STILL IN BUSINESS OF HIS HAWKER STALL.

Day 1 admission (pre-op)

Day 2

Day 7

After 1 months

After 2 months

After 3 months
CASE STUDY 7
CASE STUDY 7
MRS A, 33 YEARS OLD, Female, HOME MAKER
PARA 1, YOUNG DIABETIC SINCE HER GESTATION PERIOD
MRS A STARTED DEVELOPING ULCER AT THE RIGHT FOOT FROM PRICK INJURY, BUT SHE NEVER REALIZED OF THE INJURY UNTIL INFECTION HAS SPREAD TO ENTIRE FOOT, CAUSING SWELLING AND DISCHARGE , PUS MAINLY FROM RIGHT 4TH & 5TH TOE, NECROTIC PATCH AT MID PLANTAR REGION. SHE WAS ADMITTED TO A TERTIARY GOVERNMENT HEALTH CENTER AND WAS WARRANTED FOR RIGHT BKA. PATIENT SOOK TREATMENT FROM OUR CENTER AS SHE DID NOT WANT TO UNDERGO AMPUTATION.
ECG: NORMAL
NEUROPATHY | +++ |
DPA | Palpable ++ |
PTA | Palpable ++ |
ABPI | 0.9 |
DOPPLER | ++ |
- Of The Affected Limb
WITH GOOD FAMILY SUPPORT, HER NUTRITION SCORE was POOR TO MODERATE
GLYCEMIC CONTROL was POOR. No Pre diabetic FOOTWEAR.
DIAGNOSIS: – RIGHT DIABETIC FOOT ULCER, WAGNER (ULCER) STAGE 4; PEDIS (INFECTION) GRADE 3.
MrS.A UNDERWENT EXTENSIVE DEBRIDEMENT, THROUGH MID-PLANTAR APPROACH & SERIAL TISSUE REPAIR. SINUS TRACT EXPLORATION AND DEBRIDEMENT WAS DONE. FLEXOR TENDON REMOVED FOR 3RD TO 5TH TOE. GREAT TOE TISSUE REPAIR WAS ALSO DONE.
SUBSEQUENT FOLLOW UPS SHE WENT THROUGH SERIAL DEBRIDEMENT, TISSUE REPAIR WITH ADVANCE WOUND DRESSING. WOUND HEALING ACHIEVED AFTER 5 MONTHS.
TODAY SHE IS HAPPILY HOME MAKING WITHOUT AMPUTATION
POST HEALING: TOTAL CONTACT INSOLE AND OUTDOOR SANDAL PRESCRIBED FOR EASE OF EVERYDAY LIFE.
COMPLIANCY IS ALWAYS AN ISSUE

Day 1 admission (pre-op)

Day 6

Day 21

After 3 months

After 5 months
CASE STUDY 8
MR CS, 56 YEARS OLD INDIAN, RETIRED ESTATE LABORER
ACTIVE SMOKER, OCCASIONAL ALCOHOL CONSUMER, DM FOR OVER 15 YEARS
MR CS DEVELOPED LEFT ANKLE WOUND SINCE 3 WEEKS AGO, NO PRIOR TREATMENT ELSEWHERE BUT FROM TERTIARY GOVERNMENT HEALTH CENTER HE WAS PROPOSED FOR LEFT BKA, BUT PATIENT REFUSED.
OTHER COMORBIDS – HYPERTENSION, DYSLIPIDEMIA, ISCHEMIC HEART DISEASE
ECG – SINUS TACHYCARDIA, NO OTHER CHANGES
NEUROPATHY | ++ |
DPA | Palpable +++ |
PTA | Palpable +++ |
ABPI | 0.9 |
DOPPLER | ++ |
* Of The Affected Limb
X-RAY: NON ABNORMALITIES DETECTED
GLYCEMIC CONTROL was POOR. NUTRITION SCORE was MODERATE
No pre diabetic FOOTWEAR. FAMILY SUPPORT AND HOME CARE WAS GOOD
DIAGNOSIS: – LEFT DIABETIC FOOT ULCER, WAGNER (ULCER) STAGE 4; PEDIS (INFECTION) GRADE 3.
Mr.CS underwent extensive debridement & SERIAL TISSUE REPAIR. SURGICAL VACCUM DRAIN WAS USED TO EVACUATE THE COLLECTION OF PUS. Subsequent follow ups he went through serial debridement’s AND TISSUE REPAIR ALONG WITH advance wound dressing. WOUND HEALING achieved IN 3 MONTHS WITH PROPER OFFLOADING.
POST HEALING: TOTAL CONTACT INSOLE AND OUTDOOR SANDAL PRESCRIBED. UP TILL NOW NO RECURRENCE.

Day 1

1 MONTHS

3 MONTHS