Patient: Hi,I need a medical opinion on what to do with a type 4 ulcer on a foot. The patient has type 2 Dm, on renal failure (dialysis every 2 days), has a weakened heart function, on oxygen mask, has fluid on his lungs. The general surgeon is delaying doing any procedure due to heart, but the foot has progressively turned into a black purplish color.The patient has been receiving iv antibiotics. Can any doctor recommend placing a stent on the foot or hyperbaric oxygen therapy? Or to prevent risk of sepsis or further spreading of gangrene, is it better to have it amputated?Thank you so much for the help!
Doctor: Hello. Welcome to ask the doctor.I understand your concern.Long term Diabetes Mellitus can lead to various compl ications including Neuropathy and microangiopathy. As a result of neuropathy, the sensations of touch and pain are lost which results in unnoticed trauma and hence recurrent ulcerations and gangrene.Any kind of surgery cannot be planned until the blood sugar levels of the patient are uncontrolled.Till that time, ulcer foot can be managed by conservative methods. Patient is given systemic antibiotics.But if sepsis has set in, the ultimate treatment is amputation of the gangrenous part. He would also require anti-platelet drugs to help preventing further microangiopathy. The key is to get the blood sugar under proper control.You should see a Diabetologist and a surgeon for this purpose.I hope it helps.Stay Healthy