Case: Cellulitis of the Arm - Warning unpleasnt pictures

People often wait too long before they present to the hospital.  Sometimes it is their fault.  They think things will get better or they seek “local medicine” from a healer before they present to the BMC.  For those living in very rural villages though it can be very difficult to find their way to the hospital.  The roads to many villages are very bad and sometime impassible during times of the year like the rainy season.  Some have no means of transportation so they wait until a moto or truck comes by their village.  Sometimes that will be even a week until the next market day to be able to hitch a ride out of the village. 

What this means to us and the BMC is that people present often very ill and in conditions that are far worse than if they had come to the BMC earlier.  If they have taken local medicine they can also be much sicker from the toxins in it.  Infectious disease cases of course are the worse.  During the last two weeks, I have seen many cases that have presented too late.  Some has caused the death of the patient, others great injury that will be life debilitating.

Cellulitis if untreated will continue to spread on the limb and infect and necrosis the underlying tissue.  Often patients with cellulitis fail to present early because although they might have some mild swelling of the leg their skin remains intact and so the think the illness will resolve on its own.  They often present in very late stages with necrosis of the skin and underlying subcutaneous tissue and fascia.  These are devastating cases because you basically have to remove all of that dead tissue, usually to the underlying muscle of the limb, leaving massive wounds.  After wide debridement, they are treated with antibiotics and dressing changes and as soon as the wounds are clean with good pink healthy tissue then skin grafts will be placed.  The grafts will sometimes work, but often patients end up with chronic wounds, contractures, and sometimes eventual amputation.  I always disliked taking care of these cases and I was hoping that during this visit I might get away without seeing one or needing to perform a big soft tissue debridement, but no such luck.  Below are the pictures of a man’s arm before and after his several trip to the theatre for debridement.

Warning Unpleasant Pictures Below:

The dead skin continued around his entire arm.  You can see it is too his wrist on the left and up past his elbow.  His hand out of the picture was very swollen, but the skin heathy.

At the beginning of his second debridement.  You can see that he still has more dead skin and fascia to remove in this picture off to the right.  The pink tissue on the right is the muscles of his arm.