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Patient Centered Clinical Outcome Research at TAG VHS Diabetes Research Centre
The Future of Wound Healing
Pilot studies on musculoskeletal pains, chronic static Lymphoedema of Lower limbs (including Filariasis) Acute and chronic superficial and deep wounds (ulcers, including diabetic foot ulcerations using Topical Volcanic Ash therapy.
Case 1
Mrs. IC was admitted in a very critical condition after 6 weeks of irregular and inappropriate treatment of a diabetic foot ulcer (left great toe) which had resulted in gangrene. Clinically she was diabetic for 20 years, had been suffering from mild mitral stenosis since child hood, hypertension / CAD for 10 years & age related macular degeneration (AMD) for the past 10 years. O/E: She presented with massive oedema – anasarca, excruciating pain needing powerful parenteral analgesics, a septicaemic state with generalised skin rashes, left foot ulcer, 1st & 2nd toe discoloration +, wet gangrene, ascending upto the level of ankle. On 31/08/2011 she underwent wound debridement done by Dr. Sandeep Murali Ms FRCS under spinal anesthesia. 1st & 2nd toes were removed along with 1st & 2nd metatarsal bones. Following this she underwent regular dressing. There was no improvement in healing; also there was discoloration of skin upto the ankle. The opposite leg also developed blisters on the dorsum of the foot which were deroofed during regular dressing. Later she developed superficial blebs & ulceration on both the legs - more on the right, marked edematous state, there was extensive haemorrhagic rash seen on both legs. After intensive medical treatment of her condition, correction of anaemia with blood transfusions, stopping of gastric bleed using medical treatment + BM pulser therapy and later catheterisation to relieve a massive retention of urine and resultant haemorrhagic cystitis, her general condition and clinical status improved.
Her septicaemic state was vastly improved and she started taking oral feeds (after removal of Naso Gastric tube). Dr. Sandeep Murali saw her on 14/09/2011 and found that the infection in the left foot had completely subsided particularly after she was given a special volcanic ash dressing, but there was significant ischaemic state in the left foot which he felt might necessitate a BKA at a near future date. He also felt that the right foot had good capillary circulation and no infection and should heel with proper, regular dressing. Hence after discussion with Dr. C.V. Krishnaswami and respecting patient’s own wishes and eagerness to go home for atleast a short while, she was discharged in a reasonably good clinical status, nontoxic and able to eat oral diet and much relief from the excruciating pain that she was suffering. She was discharged with the following advice. 1. Bed rest with gentle physiotherapy. 2. Intermittent oxygen & breathing exercises. 3. Volcanic ash dressing daily for the both the legs as directed. 4. Medication as outlined. 5. Diet as advised. 6. Catheter insitu. 7. Advised BIPAP machine for respiratory distress at home. 8. To report after 1 week for review with our team and the surgeons. In case there is any problem, to review earlier.
Left Lower Limb
Immediately after Debridement & before Ash therapy (Left Leg)
10 days after Debridement & Ash therapy
Right Lower Limb
Before Ash therapy
After Ash therapy
Case 2
Mr. V.V.N was admitted on 10/09/2011 with A deep excavating ulcer on the dorsum of right foot exposing the tendon and gangrene of right little toe. Topical volcanic ash dressing was applied over the ulcer for 5 days. This resulted in significant reduction in the depth and width of the ulcer. He also had a viral infection which was treated symptomatically.
Before Ash therapy
After Ash therapy
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