Henna masquerading as necrosis

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A 64-year-old lady from North Africa with type 2 diabetes of 12 years' duration and peripheral neuropathy was admitted to hospital with severe sepsis of her left foot and a neuropathic ulcer on the apex of her left 1st toe. Her pedal pulses were bounding. She was extremely reluctant to come into hospital saying that she preferred traditional remedies. However, she agreed to have intravenous antibiotics and callus debrided from around the ulcer but she refused to have a dressing put on the foot.

Forty-eight hours later the nurses noticed that her entire forefoot had turned black and the foot clinic team was telephoned from the ward and told that she had 'spreading gangrene' (Fig. 6.30). The patient's daughter had visited the previous evening bringing with her some henna which is a traditional wound-healing folk remedy in North Africa. Unknown to the nurses she had made up a paste of henna and water and put it on her foot, which was the cause of the black staining. It was now difficult to assess the foot since the cellulitis and the colour of the wound bed were changed and masked by the henna, and she agreed not to repeat the process. The swelling associated with the infection reduced and the ulcer became smaller and dryer.

She remained in hospital for a further 10 days, during which time she applied table salt to the wound bed four times a day with her meals, and she continued this prac tice after discharge. The ulcer healed in 6 weeks and she agreed to attend regularly for callus removal and did so until she died of a myocardial infarct 2 years later.

Key points

• All that blackens is not gangrene!

• Gangrene cannot be diagnosed from a telephone call

• Immediate direct inspection of the foot is necessary

• We discuss folk remedies with our patients and try to be aware of local traditions

• Topical applications such as henna, which stain the wound bed and surrounding tissue, render wound assessment difficult.

What does the word gangrene mean?

Gangrene means tissue death. There are two kinds of gangrene. One—wet gangrene—is caused by infection. The other type of gangrene—dry gangrene—is caused by a poor blood supply. When not enough blood reaches a part of the foot, the skin and flesh may die and change colour to brown or black. This is gangrene, also called necrosis.

How would I know if I was getting gangrene?

The first signs of gangrene may be that an area of the foot changes colour. It may or may not be painful. Part of the foot usually develops a bluish or purple colour.

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