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D/D Diabetic ulcer with poor glycemic control Neurotropic ulcer If its painful its may be of arterial origin If its non painful may be its venous ulcer.. Rule out peripheral vascular disease and if burnt ulcer rule out maintaining cause.. Seen in some Leprosy patients... must be rule out.. Dressing must be done daily with Ns and betadine or oxum... unhealthy died margins must be cut off.. If diabetic..strict glycemic control and wound hygiene must be maintained... and obviously broad spectrum antibiotics and anti inflammatory analgesics...

diabetic foot with ulcerative so first control the diabetes and regular dressing nd wash wd saline nd sterlized nd give antibiotics I/v daily it's recover in one month if regular hygienic dressing nd antibiotics used

Evaluation for Leprosy. Metronidazole wash, saline dressing, MCR chappals

regular wound debridement+ dressing with oxum, gives good result.

daily wound debridement with betadine lotion periphery must be trimmed ,apply mucipirocin oint n on healthy granulation part Jatyadi taila dressing help ..sorry I have to use integrated system here this is my personal opinion

tropical ulcer.
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This may be a case of wound due to burn because of walk bare foot on tar road or may be diabetic foot ulcer. Looks like healing wound. Edges must be cut for better healing. Washing of wound with NS Use of topical antibiotics like mupirocin or fusidic acid with daily or alternate dressing. Use of systemic antibiotics like amoxi clav or cefuroxime clav as per body weight. Immunomodilators Multivitamins od If diabetic tight sugar control with insulins for better and faster out come . X ray to look for osteomyelitis Appropriate specially designed footwares to decrease load on wound which will lead to fast healing

What about neuskin....
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Which one can I use...

Using combo worked wonders in 2 cases ..pt had walked bare foot to have Gods Darshan in Dharmastala a very hot place .n got his feet burnt ..it took around 1month to heal
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@Dr. Krishna Mohan Sir

Thanks again dear Aniruddha for tagging me
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Non healing ulcer of an well controlled blood sugar patient ... How to manage???

Debridement, regular dressing is usually sufficient in cases with good glycemic control. Add an antibiotic only if the wound appears infected. In that case a culture would be helpful.
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Dear Durai Raj, This seems to be a case of Large Neuropathic Ulcer OR May be a sun burn ulcer walking barefoot, may be in hot summer in a temple which is common in our scenario. R/O Diabetes first. Wound seems to be healthy with red granulation tissue. Edges are not healthy. Investigate for FPG 2 hr PG HbA1c RFT Management. 1) Meticulous control of DM with Basal Bolus insulin 2) Absolute bed rest 3) Trimming of edges meticulously until they bleed fresh 4) Appropriate Antibiotics 5) Proper offloading 6) Hyperbaric oxygen 7) VAC Dressings 8) Split skin Graft by a Plastic surgeon. 9) Proper foot care 10) Proper foot ware. Thanks again.

Thank you Sir. What I missed Sir?
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