Dressings and postoperative care

The decision to close the wound primarily or to pack it open will vary with each case. Infected or contaminated wounds should be packed open, and either allowed to heal by secondary intention or brought back to the operating theatre for delayed wound closure. Dressings consist of a dry sterile compression gauze bandage with the hallux splinted in its proper alignment. The patient is instructed to rest at home, remain non-weightbearing and elevate his feet for 48 h. If the wound was packed open, the dressing is changed on the first or second postoperative day. If possible, arrangements should be made for a visiting nurse to perform the necessary daily dressing changes. The patient is then allowed limited protected weight-bearing in a walking brace. The first postoperative visit is scheduled within 1 week with weekly visits scheduled until the wound is healed. Once healed, the patient will require therapeutic shoes and insoles.

Fig. 8.11 Preoperative appearance of a chronic ulcer beneath the tibial (medial) sesamoid, left foot.

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