Treatment for a grade 4 diabetic foot patient with necrotizing fasciitis

Abstract

Abstract Rationale: Grade 4 diabetic foot with necrotizing fasciitis is a severe infection that can cause septicemia, amputation and even death. Timely control of infection is the key measure in the treatment of diabetic foot with necrotizing fasciitis. Patient concerns: A 40-year-old male patient with long-term diabetes complicated with chronic renal insufficiency was admitted with grade 4 diabetic foot with necrotizing fasciitis. The patient had a concurrent nutritional deficiency and anemia. Diagnoses: The patient was diagnosed with type 2 diabetes mellitus, grade 4 diabetic foot with necrotizing fasciitis, chronic renal insufficiency, acute renal failure, hypoproteinemia, and moderate anemia. Interventions: Treatment with systemic antibiotics combined with dexamethasone was performed for eliminating systemic infection. Debridement was done to remove the devitalized tissues while preserving the skin of the ankle and calf. Outcomes: During the treatment procedure, the necrotic 2nd to 5th toe was removed. The infection gradually decreased after half a month of systemic treatment which included antibiotics combined with dexamethasone mainly, combined with local dressing of the wound. Hence high location amputation was avoided. Lessons: The application of antibiotics combined with dexamethasone in diabetic foot patient with necrotizing fasciitis can be an effective measure to reduce the risk of diabetic foot amputation and death.