Page 63 - Virtual Vascular Vol 9
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Diabetic Foot
OSCE, March 2021
A 75 years old man, an ex-smoker, suffered from diabetes mellitus and renal impair-
ment. He complained of pain over his right second toe for one month. The photos
showed a typical dry gangrene appearance indicating peripheral arterial disease
with gangrene. He was managed conservatively due to his co-morbidities.
3 weeks later the patient presented with increasing pain over the forefoot, some swelling, and
chills. There is obvious increasing swelling of his forefoot and planter spaces, with marked ten-
derness. A diagnosis of infection with systemic sepsis was made.
He was admitted into hospital. Intravenous antibiotics followed by a debridement is necessary
to remove the source of infection. Subsequently revascularization is considered to improve the
distal circulation and provide the best healing environment.
His right femoral pulse was reduced and hardened, and distal pulses were not palpable.
Patients with critical lower limb ischemia generally has a guarded long term prognosis and their
overall five year survival rate can only be 50%.
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