Indexing Title: MJSCABAHUG’s Medical Anecdotal Report [05-08] 

MAR Title:  Limb-saving MJ’s solution 

Date of Medical Observation: August 2005

Narration:

A known Diabetic Patient was referred to us because of a non-healing wound on the right foot.  Upon examination, we noted wet gangrene on the first digit and part of the plantar surface.

The patient was seen by our service consultant and was advised Below the Knee Amputation.  The patient refused. 

He was admitted for five days before he gave consent not for Below the Knee Amputation but for Disarticulation of the first digit and debridement

I did the operation and left the wound open.  Wound flushing twice daily was done using a concoction of solutions.

The patient was sent home after ten days of diligent wound flushing. 

He was very happy when I announced to him he can go home.  I saw a glow in his face when he bid farewell and said thank you.

Insight (Physical, Psychosocial, Ethical) (Discovery, Stimulus, Reinforcements):

 We see many cases of diabetic foot in our department.  Right and left we easily decide to do Below the Knee Amputation and Above the Knee Amputation. 

We fail to look at the psychological effect on the patient.

As doctors, though we know what is best for the patient, we should provide options and let the patient decide. 

We should respect their decision and do our best in healing the person.

As much as possible we should be conservative with our management especially on patients with no sepsis.      

Wound care for those with wet gangrene and advise foot care as prevention to all those with diabetes.

The composition of MJ’s solution is not only the cleansing solution per se.  It also includes the following:

      1.  be conservative of one’s decision

      2.  provide options of treatment

      3.  be diligent in doing wound care

      4.  treat the co-morbidities

      5.  educate the patients of their disease condition and its prevention