Indexing Title: JGUERRA’s Medical Anecdotal Report [04-1]

MAR Title: Physical Examination Findings as Basis for Level of Amputation in Patients with Diabetic Gangrene

 Date of Observation: April 13, 2004

Narration:

Patient D.D 56M/M came in at Surgey ER with a chief complaint of nonhealing wound on the right leg for 3 months. Patient is a known diabetic for 8 yrs with history of poor compliance to OHA. Admitting diagnosis was Diabetic gangrene, dry, d/3^rd  leg R and the contemplated procedure was BKA. On PE, the leg was noted to dry with blackish discoloration up to the middle third of the leg, and demarcation of temperature on the same level. Without the luxury of a duplex scan, level of amputation was based on the parameters set by the department; temperature level, pulse , bleeding and muscle color. Patient was sent to OR for the contemplated procedure. After few days of ward stay, patient was discharged improved. (Prior to admission, patient sought consult to a private MD, and a battery of scans were requested; xray, Doppler scan, etc)

Insights (Discovery, Stimulus, REINFORCEMENT):

With physical examination findings alone level of amputation can be correctly decided. Surgeons don’t  need to request for doppler or duplex scan to help surgical decision making. More or less, certainty of surgical decision based on the said parameters can go as high as 90%.