A 62-year old diabetic black man presents in the emergency room with a swollen l

Question

A 62-year old diabetic black man presents in the emergency room with a swollen left leg with areas of blanching and blue mottling. A "foul odor" is coming from a dressed wound. The physicians remove the dressing and a brownish fluid is seeping from a wounded area. The fluid contains what appear to be small bits of the tissue. No pus appears to be present. The wound has a strong "rotten" odor. Five days earlier, while at his work as a farmer, he caught the leg in his manure spreader, sustaining a deep, crushing, grossly dirty injury. His wife cleaned the wound as well as she could with soap and water, dressed it with clean gauze, and wrapped it tightly with an elastic bandage to stop the bleeding. The second day they redressed the wound and applied triple antibiotic ointment. The patient treated his pain with ibuprofen (Advil). He reported the pain was not very bad for the first 72 hours. In the past 24 hours, the leg swelled and the mottling began to appear. A foul odor and severe pain accompanied the swelling. His wife convinced him to come to the emergency room even though they did not have medical insurance. 1. What is your diagnosis in this case? 2. How should this wound be treated? 3. Is this a life-threatening condition? 4. Is it likely that the patient's diabetes contributed to the problem as presented?

Explanation / Answer

Please find the answers below:

Answer 1: According to the information, the wound of the patient begin rottin after 72 hours even after maintaining proper hygein. This observation along with the finding of swelling and mottling in the wound and leg suggest strongly that the patient is suffering form diabetes mellitus with very high blood sugar content. This high sugar content allowed the anaerobic bacteria to flourish on the wound and thus promoted rapid rottening of the tissue.

Answer 2: In order to treat the wound, it must be first cleaned aseptically and re-dressed every 18-24 hours to maintain hygein. Further, immediate maintenace and regulation of the blood-sugar content of the patient must be performed using appropriate anti-diabetic drugs.

Answer 3: The situation is not life-threatening as of now but can lead to permanent damage to the limb if immediate medical attention is not provided.

Answer 4: Considering the case history and the age of the patient, it is extremely very likely that diabetes contributed to the present problem.

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