Diabetic foot wound Care

Non healing stump ulcer following amputation

This patient was referred to us by a physician. He had undergone right great toe amputation at another hospital 3 months before he came to us. The stump site ulcer was not healing with regular dressing. The patient was also being allowed to walk on the operated foot with the wrong belief that walking would increase the blood supply to the ulcer and help it heal.The second toe was also turning dark. On evaluation the stump bone was infected (osteomyelitis) and blood supply was compromised. We excised the infected part of the bone and closed the stump. This was followed by peripheral angioplasty of the right lower limb, The 2 nd toe tip demarcated and a partial toe amputation was done. The foot was salvaged and patient is ambulant on moulded footwear.

Heart wise a salvaged but deformed foot is better than no foot
The patient turned up in our OPD with foul smelling discharge from left foot and wet gangrene of left 3/4/5 toes.He underwent debridement ,revascularisation,ozone therapy,vac therapy and ssg of the foot.Though his foot is deformed it is better than having a below knee amputation stump which would have increased the workload on his already compromised heart by all most 50 percent
when compared to his partial foot amputation limb salvage.Increase in workload leads to higher probability of cardiac events and higher 5 year mortality rates.

Venous ulcer in non diabetic patient

This patient was brought to us with a non healing ulcer of the left foot of 3 years duration.He had lost his lesser toes in a machinery accident 10-15 years back.The ulcer had been grafted earlier in another hospital but graft failed to take up.On vascular evaluation he was found to have adequate blood supply but the valves of his superficial leg veins were found to be incompetent with reflux .He underwent laser ablation of the varicosities which was followed by debridement,vac , culture specific antibiotics and ssg.The graft took up well and patient is now ambulant on moulded foot wear.

This patient was referred to us for limb salvage with osteomyelitis of the forefoot /ankle joint after debridement and Hyperbaric therapy for necrotising fascitis.He was in sepsis and underwent redebridement(which revealed a
plantar abscess/infection) ,bone curretage and vac initially.Antibiotic laden bead cement temporary spacers and stimulan beads were used initially to fill the bone defects and treat the osteomyelitis .Integra (dermal substitute /implant)and vac was used to cover the exposed forefoot bones.Once granulation was satisfactory split skin grafting was done and ozone therapy initiated.Chorionic membrane dressings were used cover areas with poor graft take.As the extensor tendons were removed in the initial debridement he had a foot drop which is to be corrected with ankle foot orthoses.

Eighth stem cell transfer

This patient had been advised a left below knee amputation at another hospital for a severely ischemic diabetic foot that was turning black after removing the gangrenous part . A senior pediatric surgeon who knew our work with limb salvage advised the patients son and husband to consult us. The patient underwent vascular evaluation. The arteries of the left leg had extensive disease and though peripheral angioplasty was attempted it had to be abandoned as the vessels were too difficult to navigate. The patient underwent a stem cell transfer after amputation and debridement of the gangrenous part. The stump slowly started granulating and looking less ischemic with proper wound care .The wound was grafted and healed. After almost 4 month of treatment the foot was saved and patient is to be ambulated on moulded footwear.

We performed our 10 th Stem cell tranfer in non revascularisable ischemic diabetic limbs. Sharing the video of the process to know create awareness about it's simplicity and low risk.

Stem cell transfer for non-revascularisable diabetic feet and POVD This video show the steps in stem cells transfer for limb salvage in patients whose blood supply to limbs cannot be improved through angioplasty or vascular...

Great Toe salvage

This patient with an infected toe abscess/ulcer and osteomyelitis was referred to us by another patient whose chronic non healing ulcer was treated till healing by our department. He was being treated at another hospital and was on the verge of great toe amputation. We were lucky and happy to have been able to save the toe with debridements, bone curretages, vac therapy and split skin grafting.

Limb salvage of partially amputated and debrided foot.
This patient came to us after seeing some of our informative videos on YouTube. We were cautious in explaining the possible outcomes as the foot was borderline tending towards a below knee amputation because of infection and bone involvements (osteomyelitis) . But they had greater faith in God and us than we had in our selves and were willing to risk it all in an attempt to salvage the remaining foot. We lost one toe to infection and gangrene but in the final outcome the end the foot was saved.

https://youtu.be/JaKp2Hx462A?si=0f8_L0AqW6nscoqd

Some of our teams successful diabetic foot limb salvages over last 2years.#diabeticfoot Over the past 2 years we were able to save quite a few diabetic feet which were moving toward below or above knee amputations.

This patient came to us with nonhealing ulcer of tendo achilles region and lateral heel. He had undergone treatment elsewhere but the wound failed to improve.With revascularisation debridement and proper wound care we were able to salvage the foot.

Management of non healing tendo achilles and heel ulcers of diabetic foot#diabeticfoot Stages of healing of non healing ulcer with wound management

Toe salvage
This patient came to us directly from the airport, he was working abroad and developed a small wound over the great toe that rapidly turned into an abscess . Incision and drainage with dressing was done at a hospital there. As the wound was not improving and surgeons were considering toe amputation he turned up at our opd. We debrided the wound thouroughly, placed a vac and did a split skin grafting after the ulcer had granulated well. The toe healed and he is now ambulant and back to work on diabetic footwear .

https://www.youtube.com/watch?v=3w-iV__SNfg

എന്തുകൊണ്ട് ഡയബറ്റിക് വന്നു കാലു മുറിച്ചു മാറ്റേണ്ടിവരുന്നു ? | Diabetic Foot Ulcers For more health related videos, visit Arogya Kaumudy :https://www.youtube.com/arogyakaumudySubscribe Arogya Kaumudy channel : https://www.youtube.com/arogyak...

Antibiotic beads for toe osteomyelitis
With Final result

Antibiotic laden beads for osteomyelitis of great toe#diabeticfoot #stimulan#podiatry#osteomyelitis Antibiotic laden beads for treatment of toe ulcers with osteomyelitis.

https://www.youtube.com/watch?v=0nT3Qb72_wY

Corn/Plantar Wart excision A corn is different from a callosity as it is deeper and painful.It should be differentiated from a wart which is also painful but caused by a viral infectio...

Correction of fixed flexion deformity great toe with final result

Correction of great toe fixed flexion deformity. Flexor tenotomy,osteotomy,k wiring for fixed flexion deformity (Clawing ) right great toe with nonhealing ulcer with final results ...

https://www.youtube.com/watch?v=t4cDAk_8KUc&t=2s

Diabetic foot assessment for doctors(Malayalam and English) This video is a guide to assessment of a patient with diabetic foot problems.

Long standing Venous ulcers

This patient came to us with multiple ulcers over bilateral lower limbs of 12 years duration. On evaluation he had varicose veins due to faulty non return valves of his veins (incompetent sfj and perforators) and ulcers which were infected by Multidrug resistant bacteria. He underwent endo venous laser treatment of the right leg by our interventional radiologist and proper wound care using culture directed antibiotics, polyurethane foam, ozone therapy , human chorionic membrane dressing and epithelial growth factors which resulted in healing of the wound within 2 months

Ankle joint septic arthritis

Presented to Opd with pus discharge from Right ankle medial aspect. Was being treated in chennai.The wound continued to deteriorate hence came to us for a second opinion. We debrided the wound, started culture (tissue and bone) specific antibiotics, once wound was clean we initiated PRP /PRF treatment as granulation was not satisfactory with vac alone. The wound responded to treatment and the wound was prepared for ssg. Ssg was done and wound has now completely healed and patient is ambulant on foot wear.

Green with Pseudomonas

This patient was referred to us by a Senior hyperbaric specialist.The patient had undergone debridement at another hospital but the wound had turned a dark green .This is characteristic of Pseudomonas, bacteria that release a pigment pseudocyanin into surrounding tissue giving it the charachteristic green color. Multidrug resistant strains of this bacteria such as this one are difficult to treat. With inputs from infectious diseases specialist, multiple debridements, vac therapy and dressings/irrigation with dilute acetic acid( vinegar) we were able to control the infection and make the wound bed fit for grafting.

Vasculitis with painful diabetic foot ulcer

This patient was refered to us by a senior plastic surgeon who knows our team's dedication to limb salvage. She had undergone 2nd and third toe amputation at local hospital with debridement. Though her foot pulses were well heard on hand held doppler, her toes continued to turn black.Also unlike neuropathic ulcers of diabetic foot which are painless her ulcers were painful and tender Biopsy from the ulcer and Tcpo2 revealed that she had microangiopathy affecting the extremely small vessels of the foot. With proper medication and proper wound care involving debridement, antibiotics,vacs and ssg we were able to salvage the foot .

Extreme midfoot limb salvage

This patient presented to our opd with a referral for below knee amputation as midfoot amputation had been tried at another hospital following which the stump had turned gangrenous with infection. After vascular evaluation, revascularisation, multiple debridements, vacs and ssg we were finally able to salvage the foot at midfoot level.

A tailors tale and the importance of xray in diabetic foot ulcers

A tailor visited our opd with complaints of a non healing ulcer with discharge over the right great toe. She was being treated with oral antibiotics and regular dressing at a local hospital since 3 months but the wound refused to heal and continued to deteriorate. Suspecting osteomyelitis an x ray was taken which revealed the true cause of the great toe ulcer. It was a broken part of a stitching needle embedded in the toe. Since she had diabetic neuropathy and loss of sensation she did not feel any pain when the needle had pierced her toe and continued to walk on it aggravating the condition.
We were able to heal the wound
Experiences like this reinforce the importance of wearing protective diabetic footwear at home and daily self foot examination .The significance of a xray imaging in foot ulcers should not be underestimated.

What cannot be measured cannot be improved.

At our clinic we make an effort to measure the area of every foot ulcer or wound before we commence treatment and during followup/treatment. This way we are able to monitor the progress of wound healing and decide on what dressing or which intervention is most effective and at what stage of ulcer healing.

Extreme Limb Salvage

This patient came with a diabetic foot ulcer partially debrided with purulent discharge from the foot. He had renal failure, was in sepsis and was undergoing maintenance dialysis . It was clear that the ankle and foot bones were infected and we had very little hope to salvage the foot and a below knee amputation seemed to be the best option but with the sheer grit of the patient and his family our team was able to salvage the foot with multiple debridements, vac therapy, culture specific antibiotics and ssg.

Non healing diabetic surgical thigh wounds

A patient presented with a non healing ulcer over the left thigh of more than 3 month duration. He had been treated with a fasciotomy and drainage of a thigh abscess at a local hospital. Very often abscesses involve and infect the fascia.A fasciotomy alone is dangerous as it may allow pe*******on of the infection into deeper planes from the infected fascia..or the fascia may remain a chronic source of infection preventing the healing of the wound. An extensive debridement with removal of the infected fascia i.e fasciectomy instead of fasciotomy (where only the fascia is incised) is the preferred surgical treatment. In this case vac therapy and ssg was done after extensive debridement and fasciectomy finally resulting in healing of the wound.