Professional Documents
Culture Documents
Ulcercpjithu 200330120506
Ulcercpjithu 200330120506
PRESENTATION
Indrajith K Sudhy
PG Trainee
Department Of General Surgery ,
Gauhati Medical College And Hospital
1. Patient Particulars
• Name – Mr A
• Age – 54 years
• Occupation – Driver
• Resident from – Orang
• SES – Lower middle class
• Single ulcer located over the left foot dorsum extending to the plantar aspect
occupying the distal outer aspect .
• Irregularly curved margin , with sloping edge all around with red ,blue and white
zones.
• Floor is formed by healthy granulation tissue ,with minimal slough interspersed
and with extensor tendon of 4th toe exposed ,minimal serous discharge present
• No gangrenous changes over the limb , No dilated veins , ankle joint grossly
normal.
• Areas of pressure points – normal.
PALPATION
• Temperature normal over the ulcer and surrounding area.
• Ulcer and the surrounding area is mildly tender
• Measurements of the ulcer : 8.5 * 7 cm
• Other inspector findings are confirmed.
• Base : formed by the muscles over dorsum and plantar, mildly indurated
,granulation tissue bleeds on touch,distal portion of the fifth metatarsal is palpable
beneath the granulation tissue.
• Web spaces normal. Long bones normal.
• Capillary filling and refill time - normal (b/l)
• No inguinal lymphadenopathy (b/l)
• No peripheral nerve thickening
Right Left (affected)
Peripheral pulse DPA (+); ATA (+); PTA (+); Pop. A (+); DPA (+); ATA (+); PTA (+); Pop. A (+);
Femoral A(++); RA (++); UA (++); Br A Femoral A(++); RA (++); UA (++); Br A
(++); Ax A (++); Subcl A (++); Carotid A (++); Ax A (++); Subcl A (++); Carotid A
(++); STA (++). (++); STA (++).
Neurological
sensation-Vibration Diminished
proprioception,pain Diminished
monofilament test,
Ankle reflex 0 0
knee reflex + +
Power N N
Measurements
Length 85 cm 85 cm
Muscle bulk 33 (ak), 31(calf) 33 (ak), 31(calf)
Range’movements
Flexion 20◦ <10◦
Extension 50◦ 40◦
Pronation 30◦ 10◦
Supination 50◦ 20◦
Knee N N
9. Systemic Examination
• Respiratory System
Bilateral vesicular breath sounds heard; no added sounds.
• Abdomen and perineum
Soft, non tender, no visceromegaly, normal bowel sounds
heard. Perineal examination normal.
• Cardiovascular System
S1 S2 heard. No abnormal sounds heard.
• Central Nervous System and spine.
Normal.
10. Summary
• A 54 YO ,type 2 diabetic male patient come with
a complaint of pain ,swelling over the left little
toe ,followed by gangrene an purulent discharge
from the same site for 15 days. He underwent
rayamputation of the little toe and is currently
have a healing ulcer over the lateral ,dorsal and
plantar aspect of left foot .
• Clinical exam significant for 8.5*7cm ulcer with
features of peripheral neuropathy and restriction
of range of movements of ankle joint.
11. Diagnosis
Diabetic foot ulcer left side ,post ray amputation
status left 5th toe (Wagner grade 4 improved to
grade 2 ) with bilateral mixed peripheral
neuropathy .