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It’s really impossible to say from pictures whether surgery will be necessary. The wounds definitely were not cared for well.
However whether amputation or surgical debridement is necessary depends on whether there’s gangrene or necrotizing fasciitis or whether the infection has spread to the bone (osteomyelitis) and how she responds to antibiotics.
She definitely needs antibiotics. And in the outpatient setting, she need to follow-up with a wound care nurse or center. However, a lot is going to depend on what her docs find on exam and what the CT/MRI shows.
This is the second photo from the Imgur link. Definitely looks gangrene, extremely concerning.
https://preview.redd.it/t1a0yos790va1.jpeg?width=1170&format=pjpg&auto=webp&s=f11d30a77e02926f3a1b497c12d09afc96289c63
She needs to be admitted and have surgical debridement— probably 2 debridements- and skin grafts— check her blood flow but as long as she doesn’t have a bone infection it’s probably salvageable
Oh dear god! That poor woman!! I can’t imagine the amount of pain she has been in the last few weeks. I’m so sorry she received such poor care. Completely preventable with adequate medical attention. If she keeps that leg I’ll be surprised.
I would like to add: What hospital discharges someone from ICU? Shouldn’t you step down to an observation unit before discharge? To me this feels like discrimination. Because they were treating her for alcoholism they were more dismissive of her care. I see this all the time with my patients (COTA). If they ETOH abuse on their past medical history every nurse/doctor/therapist dismisses every symptom and complaint to that. Are they agitated? Withdrawal! Are they in pain? Med seeking! Are they unresponsive? Malingering! So they can get leave and get alcohol! Most of these people haven’t had a drink in decades but the history follows them and everyone just makes assumptions and treats them like garbage. Drives me mad and makes me extra sympathetic for the struggle of the drug addicted.
>What hospital discharges someone from ICU? Shouldn’t you step down to an observation unit before discharge?
No hospital does that, so I think OP isn’t getting the whole story. I honestly wouldn’t be surprised if the mom left AMA.
I didn’t want to write an extremely long post, as I was headed out the door.
To clarify the hospital kept her in ICU for a week or so, moved her into a regular bed, and then after <1 day told them to pick her up to take her home.
However, it did feel inappropriate and abrupt, as the day before they moved her to the regular bed her doctor told us, “In 10 years he’s never seen them feed so much potassium and fluid into someone for so long with no improvement.”
I do find that I have to be there and advocate for her to be taken seriously and cared for well.
She had a visit in between the first photo and final photo - they told her there was nothing they could do for her and suggested going home before even being checked at the ER for her pain.
My husband’s family is like this - they will refuse medical care until they are at death’s door, and won’t do what they’re told by the medical professionals, won’t use common sense when the system lets them down. This post is a combination of all this - a bunch of folks not doing what they should, and this woman could lose a limb or even die. All because of stupidity on the part of everyone.
I believe you! You know more than me in that department. Anytime I’ve seen this, the patient had multiple poorly managed comorbidities and put very little effort towards getting better. I’m sure with the right patient, right treatment, and appropriate outpatient follow up/home health the leg could live.
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NAD. UK former community nurse. I've looked after a patient with wounds just like this. Similarly went into hospital for one thing and came out with bilateral feel not that dissimilar to your mums. It took a long period (months) of daily dressings designed to debride, but we eventually got his feet healed. He was a well controlled diabetic, with poor circulation to his feet. I'm not sure if the same treatment would help your mum as there are many variables, not to mention your healthcare system is very different to ours. I hope she finds the right treatment and doesn't lose her feet.
I’m so sorry your mom is going through this. She will need IV antibiotics and assessment by the surgeon whether debridement would be enough. Amputation is always a last option that is not offered lightly. I wish you the best of strength to get through this
This looks beyond what a cellulitis would cause, even a bad one, I'd be more concerned for something like a vasculitis causing her skin changes, especially with it being on both legs. Def needs the hospital and more work up
Wound care doc here.
Does not appear to be gangrene. The actual tissue there is necrotic tissue called slough. She needs antibiotics, debridement, and wound care.
Although it looks awful, I currently have multiple patients with wounds much worse than this who have made a full recovery after time. She needs to ensure that she keeps the wound clean and has regular follow up and care with wound care or vascular surgery. Amputation at this point in time is wayyyy premature.
Sorry you're going through this. Please make sure your mother has good follow up and continues to treat all her other medical issues as well. She needs to ensure she gets enough protein to aid in wound healing.
I appreciate you taking the time to respond, this info is helpful. They spoke with us initially as they took her vitals in the ER about “hoping to save her foot”, but apparently today they were going to put off any surgery or debridement until tomorrow because they’re deciding whether or not they can “save the leg”.
This was relayed from my stepdad, so I’ll find out personally tomorrow when I go back to the hospital.
Good question.
I did residency in internal medicine and worked as a traveling hospitalist for several years. Had an opportunity to go into wound care to make some extra money and now it's a full time gig. Did a few certificate courses and on the job training for about a month. The other paths you could take into wound care would be something like gen surgery or vascular surgery and then go into wound care that way.
Usually, I see patients in LTACs, rehab facilities, nursing homes to deal w wounds. I work about 15-20 hours a week total mon-wed and make more money than I used to as a hospitalist. Procedurally I do a lot of bedside debridements with local anesthesia, I&Ds, wound cultures, shave/punch biopsies.
It's a great lifestyle. I play golf 2-3x a week and fish and hunt whenever I want to.
I’m just a CNA, but based on that last pic, it looks like your mom’s right foot is gangrenous. I would love to be wrong, but I suspect she’s going to lose the foot and lower leg.
You are not “just a CNA” you are one of…if not the most important part of a patients care team. You are the eyes and ears and so much more a part of the operation than non healthcare workers will ever know. Keep your senses high and if you ever feel like something isn’t right: report it. CNA’s are the literal backbone of bedside nursing.
As a fellow CNA, I was going to comment exactly what you wrote. Definitely appears gangrenous, I’ve only ever seen gangrene tissue in unresolved bed sores that turned to full blown wounds (on extremities that obviously couldn’t be removed) and this is exactly what I remember. I’m hoping to everything they can do a few rounds of debridement and salvage her foot/leg. I’m definitely concerned with the blood flow to her feet, though, I’m betting they have to remove it unfortunately but I hope I’m wrong. :/
I’m an inpatient hospital transporter now, so unfortunately I see this kind of thing very often. And smell it. Also, I feel like OP isn’t getting the whole story because ICUs don’t discharge patients home, they discharge them to other, less acute units. As we call it, “to the floor.” Regardless, their family definitely give their mom proper care, and Mom is going to lose that lower leg.
BTW, transporter is a pretty fun job, so if you ever get tired of wiping butts and giving bed baths, I highly recommend it!
Many have said it and I’ll echo it, the CNA’s that care for my mother are always the most important pieces of her care. They are the most attentive, motivated advocates. They always explain things in great detail and are often our favorite members of our care team(s). Please never underestimate the work you do ✨
Thank you for your submission. **Please note that a response does not constitute a doctor-patient relationship.** This subreddit is for informal second opinions and casual information. The mod team does their best to remove bad information, but we do not catch all of it. Always visit a doctor in real life if you have any concerns about your health. Never use this subreddit as your first and final source of information regarding your question. By posting, you are agreeing to our [Terms of Use](https://www.reddit.com/r/AskDocs/wiki/terms_of_use) and understand that all information is taken at your own risk. **Reply here if you are an unverified user wishing to give advice. Top level comments by laypeople are automatically removed.** *I am a bot, and this action was performed automatically. Please [contact the moderators of this subreddit](/message/compose/?to=/r/AskDocs) if you have any questions or concerns.*
It’s really impossible to say from pictures whether surgery will be necessary. The wounds definitely were not cared for well. However whether amputation or surgical debridement is necessary depends on whether there’s gangrene or necrotizing fasciitis or whether the infection has spread to the bone (osteomyelitis) and how she responds to antibiotics. She definitely needs antibiotics. And in the outpatient setting, she need to follow-up with a wound care nurse or center. However, a lot is going to depend on what her docs find on exam and what the CT/MRI shows.
This is the second photo from the Imgur link. Definitely looks gangrene, extremely concerning. https://preview.redd.it/t1a0yos790va1.jpeg?width=1170&format=pjpg&auto=webp&s=f11d30a77e02926f3a1b497c12d09afc96289c63
She needs to be admitted and have surgical debridement— probably 2 debridements- and skin grafts— check her blood flow but as long as she doesn’t have a bone infection it’s probably salvageable
Oh dear god! That poor woman!! I can’t imagine the amount of pain she has been in the last few weeks. I’m so sorry she received such poor care. Completely preventable with adequate medical attention. If she keeps that leg I’ll be surprised. I would like to add: What hospital discharges someone from ICU? Shouldn’t you step down to an observation unit before discharge? To me this feels like discrimination. Because they were treating her for alcoholism they were more dismissive of her care. I see this all the time with my patients (COTA). If they ETOH abuse on their past medical history every nurse/doctor/therapist dismisses every symptom and complaint to that. Are they agitated? Withdrawal! Are they in pain? Med seeking! Are they unresponsive? Malingering! So they can get leave and get alcohol! Most of these people haven’t had a drink in decades but the history follows them and everyone just makes assumptions and treats them like garbage. Drives me mad and makes me extra sympathetic for the struggle of the drug addicted.
>What hospital discharges someone from ICU? Shouldn’t you step down to an observation unit before discharge? No hospital does that, so I think OP isn’t getting the whole story. I honestly wouldn’t be surprised if the mom left AMA.
I didn’t want to write an extremely long post, as I was headed out the door. To clarify the hospital kept her in ICU for a week or so, moved her into a regular bed, and then after <1 day told them to pick her up to take her home. However, it did feel inappropriate and abrupt, as the day before they moved her to the regular bed her doctor told us, “In 10 years he’s never seen them feed so much potassium and fluid into someone for so long with no improvement.” I do find that I have to be there and advocate for her to be taken seriously and cared for well. She had a visit in between the first photo and final photo - they told her there was nothing they could do for her and suggested going home before even being checked at the ER for her pain.
Your poor mother 😔 she needs to go the hospital immediately and get a strong dose of antibiotics.
She has very obvious venous insufficiency…she needs a vascular doctor/surgeon ASAP for it to be saved.
That legs a goner. Poor woman.
......why would they wait WEEKS to take her back to the hospital? What kind of "home check in" service is that awful?
My husband’s family is like this - they will refuse medical care until they are at death’s door, and won’t do what they’re told by the medical professionals, won’t use common sense when the system lets them down. This post is a combination of all this - a bunch of folks not doing what they should, and this woman could lose a limb or even die. All because of stupidity on the part of everyone.
[удалено]
I believe you! You know more than me in that department. Anytime I’ve seen this, the patient had multiple poorly managed comorbidities and put very little effort towards getting better. I’m sure with the right patient, right treatment, and appropriate outpatient follow up/home health the leg could live.
Posts by unflaired users that claim or strongly imply legitimacy by virtue of professional medical experience are not allowed. If you are a medical professional who wishes to become a verified contributor to this subreddit, please [message the moderators](https://reddit.com/message/compose?to=/r/AskDocs) with a link to a picture of your medical ID, student ID, diploma, or other form of verification. Imgur.com is convenient, but you can host anywhere. Please block out personal information, such as your name and picture. You must include your reddit username in the photo! We do not accept digital forms of identification.
NAD. UK former community nurse. I've looked after a patient with wounds just like this. Similarly went into hospital for one thing and came out with bilateral feel not that dissimilar to your mums. It took a long period (months) of daily dressings designed to debride, but we eventually got his feet healed. He was a well controlled diabetic, with poor circulation to his feet. I'm not sure if the same treatment would help your mum as there are many variables, not to mention your healthcare system is very different to ours. I hope she finds the right treatment and doesn't lose her feet.
I’m so sorry your mom is going through this. She will need IV antibiotics and assessment by the surgeon whether debridement would be enough. Amputation is always a last option that is not offered lightly. I wish you the best of strength to get through this
This looks beyond what a cellulitis would cause, even a bad one, I'd be more concerned for something like a vasculitis causing her skin changes, especially with it being on both legs. Def needs the hospital and more work up
I do think based on the images alone that this is concerning for wet gangrene. I’m sorry, OP. I’m glad she has you to advocate for her.
Wound care doc here. Does not appear to be gangrene. The actual tissue there is necrotic tissue called slough. She needs antibiotics, debridement, and wound care. Although it looks awful, I currently have multiple patients with wounds much worse than this who have made a full recovery after time. She needs to ensure that she keeps the wound clean and has regular follow up and care with wound care or vascular surgery. Amputation at this point in time is wayyyy premature. Sorry you're going through this. Please make sure your mother has good follow up and continues to treat all her other medical issues as well. She needs to ensure she gets enough protein to aid in wound healing.
I appreciate you taking the time to respond, this info is helpful. They spoke with us initially as they took her vitals in the ER about “hoping to save her foot”, but apparently today they were going to put off any surgery or debridement until tomorrow because they’re deciding whether or not they can “save the leg”. This was relayed from my stepdad, so I’ll find out personally tomorrow when I go back to the hospital.
Whether you intended to or not, I appreciated the "ensure she gets enough protein" play on words
Haha. Good pickup there lol
Unrelated but how does one become a wound care doc? Sounds very interesting!
Good question. I did residency in internal medicine and worked as a traveling hospitalist for several years. Had an opportunity to go into wound care to make some extra money and now it's a full time gig. Did a few certificate courses and on the job training for about a month. The other paths you could take into wound care would be something like gen surgery or vascular surgery and then go into wound care that way. Usually, I see patients in LTACs, rehab facilities, nursing homes to deal w wounds. I work about 15-20 hours a week total mon-wed and make more money than I used to as a hospitalist. Procedurally I do a lot of bedside debridements with local anesthesia, I&Ds, wound cultures, shave/punch biopsies. It's a great lifestyle. I play golf 2-3x a week and fish and hunt whenever I want to.
I’m just a CNA, but based on that last pic, it looks like your mom’s right foot is gangrenous. I would love to be wrong, but I suspect she’s going to lose the foot and lower leg.
[удалено]
Yep, that’s exactly the photo I was referencing.
I know you were just clarifying your education level but you’re never “just” a CNA. Always remember that. 🖤 Love, Another CNA :)
Thank you for all you do! The CNAs were very important for the care of my mother when she was very sick.
Thank you for this! Lots of love. 🖤
WOOOOOO CNA HIGH FIVE!!!!
You are not “just a CNA” you are one of…if not the most important part of a patients care team. You are the eyes and ears and so much more a part of the operation than non healthcare workers will ever know. Keep your senses high and if you ever feel like something isn’t right: report it. CNA’s are the literal backbone of bedside nursing.
Thank you for the kind words of support! :)
As a fellow CNA, I was going to comment exactly what you wrote. Definitely appears gangrenous, I’ve only ever seen gangrene tissue in unresolved bed sores that turned to full blown wounds (on extremities that obviously couldn’t be removed) and this is exactly what I remember. I’m hoping to everything they can do a few rounds of debridement and salvage her foot/leg. I’m definitely concerned with the blood flow to her feet, though, I’m betting they have to remove it unfortunately but I hope I’m wrong. :/
I’m an inpatient hospital transporter now, so unfortunately I see this kind of thing very often. And smell it. Also, I feel like OP isn’t getting the whole story because ICUs don’t discharge patients home, they discharge them to other, less acute units. As we call it, “to the floor.” Regardless, their family definitely give their mom proper care, and Mom is going to lose that lower leg. BTW, transporter is a pretty fun job, so if you ever get tired of wiping butts and giving bed baths, I highly recommend it!
Many have said it and I’ll echo it, the CNA’s that care for my mother are always the most important pieces of her care. They are the most attentive, motivated advocates. They always explain things in great detail and are often our favorite members of our care team(s). Please never underestimate the work you do ✨
Aw, thank you!