(CS-003) Case presentation :Effective application of Vaccuum Therapy to manage Sever Diabetic Foot Infection with necrotic Fascitis and Osteomyelitis (WiFi class 4)

Introduction: My patient was 67 years, neglected, Diabetic. He came with severe deteriorating general Conscious state(DKA) . He had plantar ulcer. Suddenly he had swollen deformed Foot with fever and disorientation.  He visited me at outpatient. I examined him and deduced that he had been complaining of D.F.I.   I incised part of plantar swelling and get a lot of pus about 600 ml and sent samples for Culture & antibiotics sensitivity test. Blood Samples were collected for Full lab. study that revealed CBC ;sepsis 26000, anemia HG: 5. He was in septic shock with DKA: RBG ; >500. During debridment I discovered him to had Necrotic Fascitis and wet gangrene with Acute Forefoot Osteomyelitis. He lost  alertness  , he probably might had Mr or AR.

Methods: Vaccuum Therapy application for Wound healing and Drainage after heavy surgery and Debridment was started.

Results:

• Trial revealed Clinical Success of Vaccuum Therapy in Wound Healing with 97% in Class 4 WiFi DFI.

Discussion: admitted him urgently for hospital intermediate Care for evaluation of his state. For life saving resuscitation by continous
Pumb Infusion Therapy with Insulin  till RBG stared to clarify as 500 mg /dl, then 300 mg/dl. This means that it was overshooting. He received antibiotics Cefoperazone, Sulbactam every 12 hours. The deep muscles of plantar foot arch were discharging Sever pus, so it was necrotic infection. CULTURE RESULT revealed that it was muscle eating necrotizing E – Coli combined with Pseudomonous. I taken the matter for consideration that I would not rush for above or below knee amputation, next 2 days W.B.C. decreased to 20000 then 18000, that was +ve results for Cefoperazone, Targocid and Antifungal.

Doppler was upper limit normal biphasic at knee to foot, so blood flow was sufficient. It was deep 

process that led to Forefoot Bone Abscess.

I started him blood transfusion every 12 hours, packet for 4-5 days. His Hemoglobin improved to 8 then 9 mg/dl. Vaccuum Therapy played later effectively strange Role in managing Sever Diabetic Foot Infection with necrotic Fascitis and Osteomyelitis (WiFi class 4). (Acute Charcot.)