Extensive surgical debridement, decompression or amputation may be indicated in the following clinical setting except
Superficial thrombophlebitis management This is a superficial venous thrombosis. An abnormal endothelium is a much more common precipitating factor than in most DVTs. Common causes include external trauma (especially to varicose veins), venepunctures and infusions of hyperosmolar solutions and drugs. The presence of an intravenous cannula for longer than 24-48 hours often leads to local thrombosis. Some systemic diseases such as thromboangiitis obliterans (Buerger's disease) and malignancy, especially of the pancreas, can lead to a flitting thrombophlebitis (throm bophlebitis migrans), affecting different veins at different times. Finally, coagulation disorders such as polycythaemia, thrombocytosis and sickle cell disease are often associated, as is a concomitant DVT. The surface vein feels solid and is tender on palpation. The overlying skin may be attached to the vein and in the early stages may be erythematous before gradually turning brown. A linear segment of vein of variable length can be easily palpated once the inflammation has died down. A full blood count, coagulation screen and duplex scan of the deep veins should usually be obtained. Any suggestion of an associated malignancy should be investigated usingappropriate endoscopy and imaging studies, such as an abdominal CT scan. Most patients are treated with non-steroidal anti- inflammatory drugs and topical heparinoid preparations and the condition resolves spontaneously. Rarely, infected thrombi require incision or excision. Ligation to prevent propagation into the deep veins is almost never required, although some advocate saphenofemoral ligation when the thrombus is seen on ultrasound to be at the SFJ. Associated DVT or thrombophilia is treated by anticoagulation. Ref: Bailey and love 27th edition Pgno : 990
Progressive synergistic gangrene
Acute thrombophlebitis
Acute haemolytic streptococcal cellulitis
Acute rhabdomyolysis
Urology