Int J Surg Case Rep. 2024 Jul 10;121:110012. doi: 10.1016/j.ijscr.2024.110012. Online ahead of print.

ABSTRACT

INTRODUCTION AND IMPORTANCE: DFU care in India is expensive. Cost-effective integrated care approaches for diabetic wounds are a necessity.

CASE PRESENTATION: A 54-year-old, type 2 diabetic male patient presented with bilateral Grade Four compound DFUs. He also had a peculiar pattern of progressive gangrenous lesions on both toes of his limbs. He was on medication for schizophrenia for 20 years. Doppler studies of both limbs revealed extensive atherosclerotic changes with no flow in the mid and very low flow in the distal left anterior tibial artery.

CLINICAL DISCUSSION: Along with Ayurvedic internal medication, in-home wound care was advised. Wound cleaning (shodhana) was done with Triphala decoction, gauze packing (ropana) with Gandhak druti, and application of Jatyadi oil (snehana) was done daily. The wound inspection was done using a smartphone. Out of six wounds, one infected wound measuring (8 cm-3 cm), one tunnelling wound measuring (9 cm-3 cm), one neuro-ischemic, Grade 4 planter wound, and other non-infected wounds healed within four to ten weeks. It has been observed that all the toes with progressive ischemic black spot on the proximal interphalangeal joint had deteriorated within 20-35 days.

CONCLUSION: Gandhak druti may be effective for progressive wounds. Jatyadi oil application to enhance microcirculation as a preventive therapy should be investigated. Wound dressing guidelines recommended in Ayurveda classics can be followed at diabetic wound in-home care using a smartphone. Correlative timeframe of pathophysiological signs and anatomical site of dermopathy patches can add value to the non-invasive microcirculation detection tests.

PMID:39024993 | DOI:10.1016/j.ijscr.2024.110012