A person with diabetes has a wound in his toe that turned black. What should be done now?

Question

Hi doctor,

My relative lives in the jungle and came asking for our assistance. He reported an injury to his right foot along with pain and a burning sensation in his toes and foot. The wound smelled bad, and the toes turned black. He did not have a fever. We took him to the hospital, and they advised amputation because he had diabetes.

Since he refused, they prescribed Clindamycin for seven days, Ascorbic acid for one month, Metformin for one month, and Sodium chloride solution for irrigation. He was already taking tablet Cephalexin 500 mg for seven days, tablet Clotrimazole twice daily for seven days, and using a charcoal paste. What should be done as the next step?

Kindly help.

Answer 1

Hello,

Welcome to icliniq.com.

I understand your query and acknowledge the picture attached (attachments removed to protect the patient's identity).

The images you uploaded are highly suggestive of invasive bacterial infection (gangrene) and may need amputation as advised by your physician, or else it may be life-threatening to the patient. The decomposition may spread to the adjacent areas and can also lead to a septic shock. The tissue from the wound area must be sent to the clinical microbiology laboratory to determine the etiological cause, so that appropriate antibiotic is selected for treatment.

Strict control and monitoring of blood glucose are necessary. Povidone Iodine and topical antimicrobial ointment are to be used depending upon the patient's condition. Systemic antibiotics and antifungals should be chosen based on the clinical, microbiological report and other blood investigations pertaining to clinical hematology and clinical biochemistry.

It needs invasive treatment by a general surgeon. It cannot be managed without surgical intervention.

I hope my advice helps you.

Thank you.

Regards.