Kailash son of Bherulalji, a 30-year old married Hindu male, was admitted to the surgery ward with a large infected ulcer on his left lower leg resulting from a road accident and cartwheel injury 15 days prior. He reported worsening pain, swelling, pus discharge, and discoloration of the skin around the ulcer. On examination, a large irregular ulcer was found on his lower left foot extending from his toe to ankle, with inflamed edges and sloughy floor. He underwent debridement of the necrotizing fasciitis and infected non-healing ulcer.

1. Neeraj Kumar Jain
Surgery

2. Case presentation
 Kailash son of Bherulalji ,30 year , hindu, married
male, resident of Pipliya Kheda, Prajapati Nagar,
Kaanipura Ujjain admitted in surgery ward on 22
December 2012 at 3.15pm :
 With alleged History of Road traffic accident by
cartwheel on 7 dec 2012 after which he had complaints
of
 Pain in left lower leg for 15 days.
 Swelling in left lower leg for 14 days.
 Pus Discharge from swelling for 10 days
 Ulcer over left lower leg for 10 days.

3. H/o presenting illness
 As per patient he was alright 15 days back then he had
accident with cartwheel after which he developed pain in
left lower leg which was initially dull aching , progressive
in nature gradually it has increased in intensity.
 Swelling in left lower leg for 14days which was limited to
lower leg gradually increased in size .For which he was
admitted in Some hospital and dressing was done after 4
days swelling burst opened and pus came out then swelling
decreased in size.
 Then he developed black discoloration of skin so
debridement was done.
 Since then he is having Ulcer over left lower leg associated
with Pus discharge.

4. Past history
 No History of any previous Surgery.
 No history of any long illness in past .

5. Family history:
 He is married having 4 Children .
 No history of any long illness in family.

6. Personal history
 He is Non vegetarian.
 History of smoking bidi for 8 years half bundle daily,
Tobacco chewing for 10 years, Alcohol drinking for 7
years.
 Bowel and bladder habits normal
 DRUG HISTORY
 History of taking some medication for pain.
 No history of drug allergy.

7. GENERAL EXAMINATION
 Temp not raised
 Pulse -84 per min
 Blood pressure -110/80mm Hg
 Bulbar Conjunctiva –White
 Palpable conjunctiva- pink
 Oral Hygiene-Poor
 Nails-no Koilonychia,No clubbing
 Neck veins/neck glands- not Palpable.
 Odema ,lymphadenopathy absent

8. Local examination
 Single large ulcer present on dorsum of left lower foot
extending from 5cm away from great toe to lateral
malleolus.
 Irregular shaped ,nearly 15cm * 7cm in size.
 Margin- inflamed and oedematous.
 Edge-Sloping and punched out
 Floor- Slough present
 Base-underlying Muscles and bones.
 Skin around Ulcer is hyper pigmented.

10. Palpation
 Temperature not raised
 Tenderness present
 Single large ulcer present on dorsum of left lower foot
extending from 5cm away from great toe to lateral
malleolus.
 Irregular shaped ,nearly 15cm * 7cm in size.
 Margin- inflamed and oedematous.
 Edge-Sloping and punched out
 Floor- Slough present , Bleeding present on touch at
some sites.
 Base-underlying Muscles and bones.
 Skin around Ulcer is hyper pigmented.

11. Necrotizing fasciitis of left lower leg
Traumatic Infected Non healing Ulcer on left lower leg

12. Hematological investigations
 Hb- 12.4 g/dl
 TLC- 8500/cumm
 DLC- N-62 L-30 E-06 M-02

13. Other investigations
 Urine examination-NAD.
 RBS-90mg/dl
 CREATININE-0.6mg/dl
 UREA-24.8mg/dl
 HIV & HBSAg-NR

14.  He was operated on 24 Dec and Debridement was
done.

15.  THANKING YOU