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Diabetic foot with gangrene - Online Doctor Chats

Date : 13-Jan-2012
User rating for this question
Excellent Posted in: Diabetes
Answered by

General & Family Physician
Practicing since : 2004
Answered : 1725 Questions
User :   hello sir,
my father is diabetic(meningitis type 2) from the last 16 years and recently he formed a wound in his foot
his Creatine level is 3.2 and there are hints of ganrene in his foot
wat is the possible answer to the wound?
is amputation the only answer or revascularisaon can be done?
waiting for your reply
XXXXXXXX
Doctor :   Hi
User :   hello
Doctor :  
May I know your fathers age?
User :   51 sir
Doctor :  
*father's age?
Doctor :  
Ok.
Doctor :  
he needs wound debridement.
Doctor :  
Wound debridement is not same as amputation.
User :   wat does debridement mean sir
Doctor :  
During the surgery the condition of the bone and the muscles would be observed and further surgical treatment which can include amputation would be decided.
Doctor :  
Wound debridement is a surgical procedure where all the affected tissues are excised.
Doctor :   during the post operative period the wound is allowed to heal.
Doctor :  
After successful healing a grafting procedure may be done.
User :   can a diabetic patient's wound be healing normally in observation
Doctor :  
These procedures might be modified depending on the current status of the wound and the condition as seen during the surgery.
Doctor :  
Yes, there are chances of normal healing, if the wound is not big,
Doctor :  
and if the infection is not severe,
Doctor :  
and if the diabetes is under control.
User :   its actually on the heal of the foot
User :   heel^
Doctor :   Ok.
User :   and there is some presence of gangrene
Doctor :   presence of gangrene signs is not a good sign.
User :   can it be healed?
Doctor :  
How ever the status of the arteries, how much area is gangrenous is taken into consideration, in deciding what surgery is to be performed.
Doctor :  
A fully gangrene tissue has to be excised.
Doctor :   It cannot be left behind.
User :   so u mean it can be surgically removed
Doctor :   Have you followed?
Doctor :  
yes, it has to be surgically removed.
User :   and the doctor saya there is not much blood flow
User :   says^
Doctor :   I would say this way then.
User :   sao revascularisation can be done right?
Doctor :  
The surgery that would be surgical debridement and excision of the gangrene.
User :   if the quntity of gangrene is high?
Doctor :  
If the gangrene is severe involving the major part of the foot, then amputation might be considered.
User :   quantity^
User :   its almost 1/4th of the foot
Doctor :   revascularisation surgeries would be considered if diabetes caused blockage in one of the important arteries and not small arteries.
User :   i mean towards the heel
Doctor :  
Ok.
Doctor :   Amputation would be a better treatment if you are prepared for it.
User :   can grafting be done to the heel?
Doctor :  
But atleast a surgical debridement is needed if you are not ready.
Doctor :  
Grafting would be done only if the tissues are healing well.
User :   but can this debridement result in load on kidneys?
Doctor :  
The cause for the kidney dysfunction could be the infection resulting in acute renal failure.
Doctor :  
This would be the cause if he has not had previous kidney problems.
Doctor :  
In such cases treating the infection will help in stablising the kidney.
User :   hes never had any kidney problems
Doctor :  
here in your father's case it would be the surgery and antibiotics.
User :   if it is debridement wil the wound heal
Doctor :  
I shall make it more clear.
User :   because we are definately nt ready ror amputation
User :   for^
Doctor :   following the debridement if the infection is treated with good antibiotics,
Doctor :  
if the vascularity is good,
Doctor :  
and if the diabetes is managed properly then there are good chances that the debridement surgeries will heal.
Doctor :  
if any of these are not right, then healing would be delayed.
Doctor :  
This might result in further worsening of his condition.
Doctor :   have you followed?
Doctor :  
since you mentioned that vascularity is compromised.
User :   so if my father is admitted in the hospital and debridement is done under proper observation then there are chances that the wound would heal?
Doctor :  
It depends on how bad the vascularity is affected, that will decide if the debridement surgery will help.
Doctor :  
yes, if all the parameters that i had mentioned is good.
Doctor :   have you followed?
User :   we actually wanted to keep amputation as the last answer
User :   yes sir
Doctor :   I understand.
Doctor :   I think if i can tell about a few facts of amputation here.
User :   so its better we admit him immediately befor it worsens
Doctor :  
Yes.
Doctor :  
he is good if he is admitted as the kidney status is compromised.
User :   yes sir
Doctor :  
If you are interested in knowing about amputation, i shall discuss those too.
User :   yes sir
Doctor :   See, amputation is some times done to save the life of the patient.
Doctor :  
In your father's case, it is the infection secondary to diabetes that is the problem now.
Doctor :  
If vascularity is compromised, wound healing will delay.
Doctor :  
and this can lead to further infection.
Doctor :  
Persistent infection can cause severe damage to other organs too.
Doctor :  
all these condition are the factors that make a doctor think of amputating the limb.
Doctor :  
as this procedure can prevent all those which i had mentioned.
Doctor :  
So if amputation cannot be avoided in your father, then I think it would be better you do it as early.
Doctor :  
This is only when the doctor says it cannot be avoided.
Doctor :  
Following the amputation, you have prosthesis which are good.
Doctor :  
They can help in making your dad do atleast 50% to 70% of his daily activities.
Doctor :  
Have you followed?
User :   yes sir i have
Doctor :  
Do you have any other query?
User :   so amputation can increase the life span of the patient
User :   ?
Doctor :   it would be a life saving procedure in the case of your dad, if need arises.
Doctor :   The doctors who have assessed him will able to tell you better what is the right surgical treatment now.
Doctor :  
Have you followed?
User :   so tomorrow i will take him to the hospital and ask the doctor if debridement can heal him or not
User :   if the answer is no we would consider amputation
Doctor :  
Yes. That would be the best
Doctor :   Do you have any other query?
User :   thank you very much sir
Doctor :  
Please fill the feed back form too.
User :   it was really helpful
Doctor :  
Thanks for consulting HealthcareMagic. Bye for now. Please refer your friends to our service.
User :   thanks
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