ABSTRACT
This is the most devastating clinical situation with infected diabetic foot. Deep seated foot infection is no more localized; it has disrupted all the anatomical barriers and has extended proximally, above the ankle, progressing into the leg. The patient with life threatening foot infection, often has a history of f oot inf ection f or over one month, has been treated at other places with inadequate, heisitant small incisions, and various antibiotics and has spent few days trying alternative medicine with faith healers. The patient is toxic, debilitated, pale, febrile and has tachycardia. He has extreme weakness, malaise, loss of appetite and vomiting. His laboratory investigations reveal anemia, hypoalbuminemia, chronic hyperglycemia (HbA1c > 9%), hyponatremia, raised total leukocyte counts with erythrocyte sedimentation rates > 100 mm/ 1st hr. Serum creatinine is raised with or without ketonuria. The foot is smelly, bloated and dirty. The foul smell is intolerable and unsuppressible (despite layers of bandages). The foot has a boggy appearance, has multiple openings through which there is a discharge of purulent material and the underlying necrosis is clearly visible. Crepitus (gas in the soft tissue) is often present.
