70-year-old male with a history of hypertension, peripheral vascular disease (PVD) and Type II diabetes. He was primarily admitted for a pyogenic infection to the right hallux which resulted in amputation of the right hallux. He was discharged with a course of antibiotic therapy and followed up in the foot clinic.
After several weeks of oral antimicrobials and weekly reviews, the patient presented to clinic with a tissue infection to the amputation site, and that had progressed to the 2nd toe. The MDT agreed the wound had not responded to the current medical therapy to treat the infection. The patient consented for the 2nd toe to be amputated. Proteus mirabilis & Pseudomonas aeruginosa was cultured from deep tissue and bone samples that was resistant to oral ciprofloxacin. Unfortunately, the patient discharged himself from hospital before a medical plan was completed and did not present to clinic for 2 weeks.
Treatment
The wound surface presented with a layer of biofilm but was clinically stable with no tracking cellulitis. The patient was not presenting with sepsis. The wound site was sharp debrided back to healthy bleeding granulating tissue by the podiatrist and 10cc STIMULAN mixed with antibiotic was packed into the wound. The beads were sealed in with Adaptic Touch™, non-adhering silicone contact layer, and mefix tape. A secondary layer of sterile gauze, Soffban® and crepe bandages applied to manage the exudate levels. The antibiotic beads were left undisturbed to fully resorb into the tissue and bone. Oral and intravenous antibiotics were ceased.
Outcome
The wound healed well with healthy bone mineralisation and intact cortex seen on plain x-ray. During healing the patient received one short (7 day) uneventful course of oral antibiotics for a suspected tissue infection to the same site. At 25 weeks the wound had healed and the patient and his wife were very happy with the outcome of this challenging case. The patient was then able to be discharged to local care and did not have to be readmitted to hospital.
Library
Listed below are 4 of the most relevant articles for this piece but there is much more to explore on our Library page.
