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