Gangrenous feet after stroke and DVT

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Now this is a little out of my scope of practice since I left Uni, so your advice and opinions are needed.

A little background...

The patient is my friends father-in-law, she has asked me if I can do anything to help.

The patient is a 63 year old man, as far as we can tell his medical history has been good, non-diabetic, doesn't take any meds, no systemic heath problems. He suffered a stroke on the 7 Jan and has been bed bound for 2 months. On the 13 Feb he had DVT I one of his legs. His recovery is very slow but he is breathing on his own and opens his eyes, this week has had a blood transfusion, and will then go back to a rehabilitation unit.

So, his feet, they have both become gangrenous, dry gangrene? The doctors here in Athens aren't concerned with his feet and have just dismissed them by saying amputations will be needed. Amputation in Greece seems to be very high, I'm not aware of any high risk clinics, multidisciplinary teamwork doesn't exist and podiatry isn't even a recognised health profession here! Are they recoverable, what pathway of treatment can be taken to avoid amputation? Is debridement going to be within my scope of practice, as I don't see that this is done here in Athens? Is there anything I can do to help?

Please see the attached (should be 5) photos which give a clear indication of the extent of tissue death.

 

2nd photo

 

3rd photo

 

4th photo

 

5th and final photo

 

As an ex Orthopaedic Nurse, before becoming a Pod, its pretty clear that the problem started as a pressure sore on the heel, caused by bad nursing practice, pt not being turned often enough etc. the gangrene is far beyond the remit of a Pod, any debridement should be done in theatre under epidural or GA. He will loose the smaller toes, but the rear foot looks salvageable. If they don't do something soon, the toes will just drop off. The affected skin will peel, if he is really lucky there might be some healthy skin underneath, it depends how deep it is. As they don't even recognise us as a profession, personally I wouldn't get involved, as whatever happens you will invariably get the blame and I doubt your insurance will cover you. However you could give the family advice to push for better care. I know its frustrating but sometimes we have to take a step back.

 

Consider arteriogram . Patient may have arterial thrombus.

 

How terrible. Poor man. To suffer a stroke and potentially stand to lose his limbs.
Carol is right, there is a large pressure ulcer on the heel which indicates that his care in hospital is not optimal. He needs to be turned regularly and look at some pressure deflection also.
Yes, it is dry gangrene. What is black is dead tissue so would not be salvageable.
I am with Dr Bates - he needs a vascular scan to see what the cause is - either PAD or an arterial thrombus.
I agree with Carol that you need to tread carefully here - and to be honest there is not much you can do - it is really a case for a vascular surgeon.
Good Luck

 

I agree he need som vascular surgeon and offloading the foot
Does he have some orthotoses when he is in the bed? he need to offload the heel/foot in weightbearing
Are there any samples of bacteria taken?