What Causes Necrotic Circular Lesions On The Lower Leg Near A Wound?

Posted on Fri, 29 Apr 2016

Question: Hello, I am a nurse practitioner and certified wound specialist. I have a patient with medicaid and I can not find a rheumatologist to see her. PMH: DMII HTN no autoimmune disorders. She presented with a necrotic lesions on the lower leg secondary to trauma which was debrided and treated. However she presented with 2 new necrotic circular lesions ( 1cm and 2cm ) of the lower leg without a precipitating factor. the periwound is erythematous ( not infected ) and pruritic/burning. I suspect vasculitis, however the biopsy was inconclusive.

Answered by Dr. Aashish Raghu (1 hour later)

Brief Answer:
Needs laboratory investigations, Doppler, Anti inflammatory and antibiotic

Detailed Answer:
No there.

Thanks for the query.

She needs to get a Rheumatoid panel of investigations like CRP, ESR, ALSO, Anti dS DNA, culture of the wound swabbings for Mycobacteria, streptococci needs to be done.

Also she needs to get a Doppler of the lower limbs arteries and veins to look for vasculitic narrowing.

Limb elevation, antibiotic such as Tablet Augmentin 650mg twice a day and anti inflammatory such as Tablet Ibuprofen 400mg twice a day for 5 days after meals need to be taken. Regular dressing of the wounds needs to be done.

She may need steroid therapy in the setting of vasculitis did which the laboratory investigations and Doppler can help to decide.

I hope I have answered your query.

I will be available to answer your follow up queries.

Regards,

Dr. Aashish Raghu

Note: For further queries, consult a joint and bone specialist, an Orthopaedic surgeon. Book a Call now.

Above answer was peer-reviewed by : Dr. Raju A.T