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Vascular Surgery/Gangrene on toes resulting from Septic shock/vasopressors

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Hello,
On Feb 24th my dad was rushed to the Hospital. It would up being septic shock form a dog bite a few days earlier. He needed vasopressors to help the blood pressure and as a result his feet had some gangrene on them.

He was basically in ICU for a few weeks and under care for about a month total. He is basically fine and healthy now except for some tingling in his hands (which also got cold and dark at one point) and his feet which still have gangrene.

The left foot is basically 99%. All the black has gone away and now there is just some slight discoloration and a tiny amount of puffiness on a toe or two.

The right foot/ankle is still very swollen, but a lot of the black has receded over the months. He has no feeling in the toes, but there is shooting pain and tingling every now and again. There is direct pain when he is moving his toes or walking.

The black that is left is hardened/mummified, but some pieces are slightly peeled up and below is what appears to be pinkish tissue.

His treatment to this point has been Hyperbaric Oxygen treatment daily, and he is supposed to be eating healthy. He has had a few Dr. appts. with his Vascular guy, who eventually handed him off to a Podiatrist. And he has a weekly wound care session at the H2O place.

Everybody was basically saying to just wait and see what happens, and once left foot gets as good as it is going to get decide to what to do with right foot. Now the Podiatrist wants to consult with a plastic surgery guy this week to decide if they want to remove all 5 toes on the right foot at once or do one at a time.

Is this the only option at this point or is there another option?

I personally would like to see him wait it out as long as possible in hopes of the swelling in the foot going down and maybe seeing more healthy tissue appear. In the beginning everyone was talking about losing an entire foot or two, then just half of each foot, and now just the toes on one foot. Could waiting longer prove to be beneficial at all?

I wouldn't mind seeing him have another few weeks of waiting, and possibly getting him to a nutritionist to convince him to eat 100% clean for a bit.

Thank you

Answer
Oh I am so sorry i have a new puppy and he is eating up my life, sorry it took so long to reply
i always think of gangrene as gods bandage
i agree leave it along and see what happens FOR SURE do not let them start taking one toe at a time
there is a test called transcutaneous oxygen sensors that can delineated WHERE in the anatomy an incision will heal, when ready for any needed surgery i would ask for that test to be sure the incision can actually heal many times i have seen incisions that cant heal lead to unnecessary second and third surgery
it takes nearly 405 more protein to heal than to maintain intact skin so diet and hydration are critical
a wound care specialist i admire has a vitamin program for healing
as a temp measure only, no loner than a month or two while healing only he recomends vit A 50,000 units (10,000 units daily when not wounded)
500 mg vit C twice daily
220 mg zinc sulfate twice daily
omega 3 fatty acid (fish oil) as directed on bottle or eat fish twice daily
vit D 2000 IU daily while wounded and 1000 when not

massage can help bring healing blood flow to the area, massage right up to the wound edges
relaxation, meditation acupuncture can all help
again sorry for the delay and i hope this helps
lauri

Vascular Surgery

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Lauri Ordway

Expertise

I can answer your questions related to your circulation, your peripheral vascular system. This includes all arteries and veins except those inside the head and inside the heart. For example, neck (carotid), arms (carotid subclavian bypasses to Thoracic Outlet) belly (aortic aneurysm & occlusive disorders, renal artery stenosis), legs (iliac, femoral, popliteal, peroneal, dorasalis pedis, posterior and anterior tibial) arteries. Aneurysm & occlusive disease, atherosclerosis, leg pain, arterial wounds and gangrene, amputation prevention. Arterial Bypass, Reynaud’s, Buerger's disease (thromboangiitis obliterans), Thoracic Outlet and other circulation disorders. Vein disorders: Blood Clots (DVT), post-phlebetic syndrome, varicose veins, venous stasis ulcers. I can help with vascular wounds from diagnosis to treatments. I have worked extensively with VNUS Closure and EVLT (Laser) for varicose veins and can describe pre and post procedure expectations and describe the procedures themselves. I can't help with spider veins or cosmetic vein treatment, we don't do it. I have 15 years of wound care experience, arterial, venous, trauma and diabetic wounds for example. **I CANNOT answer questions about STENTS or STENTING, heart disease, blood pressure, brain aneurysm although I can help with questions about the arteries that go to and from those organs.

Experience

I am a nurse, I worked for 15 years with two terrific peripheral vascular surgeons, and one of them is also the inventor of very innovative wound care products and surgical instruments to make vascular surgery procedures better and faster. I wrote and manage the clinic website and field questions from patients all over the world. I am now working with another vascular surgeon and wound care expert, which has given me an opportunity to widen my horizons as I learn another excellent physician's preferences and benefit from his experiences in this amazing specialty.

Education/Credentials
I am an LPN, licensed in Minnesota

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