Transform infected foot
Courtesy of Mr Martin Arissol, MSc, BSc (Hons), MRCPod, NMP, HCPC Reg. Principal Podiatrist, Cambridgeshire & Peterborough NHS Foundation Trust, England, UK
68-year-old male with a history of type 2 diabetes mellitus, asthma, and peripheral vascular disease. Ex-smoker. The patient initially underwent left 2nd toe amputation due to plantar abscess and tracking infection in a neuro-ischaemic foot. The wound did not heal post-amputation.
Angioplasty was performed on the left leg, resulting in successful superficial femoral artery (SFA) and anterior tibial artery (ATA) run-off. Further surgical debridement included resection of the infected 2nd metatarsal bone and 3rd toe amputation. Topical negative pressure therapy (TNP) applied initially but failed due to difficulties achieving an effective seal in the community setting.
Bone cultures grew E. hormaechei, E. faecalis, P. vulgaris, and K. pneumoniae (sensitive to ciprofloxacin and gentamicin). Oral ciprofloxacin was given.
2 months later, the wound cavity remained static, with exposed fascia, tendon, and bone. The wound was debrided in clinic/chairside, and the void packed with antibiotic loaded STIMULAN beads. Oral antibiotics were stopped. After 8 weeks, the STIMULAN had resorbed and a second application was performed due to ongoing cavity.
After 13 weeks, full healing was achieved. No adverse effects or further infections occurred, and the patient avoided hospital readmission with weekly outpatient follow-up.
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