Ray amputation in a neuropathic foot and its postoperative care

A 58-year-old man with type 2 diabetes of 10 years' duration, presented at casualty with a cellulitic right foot and blue 5th toe (Fig. 6.19). Pedal pulses were bounding and he did not complain of pain. He was admitted for intravenous antibiotics and a ray amputation was performed to remove all necrotic and sloughy tissue. When the dressing was 'taken down' after 48 h the wound bed was grey

Necrotic Wound Diabetic
Fig. 6.19 This neuropathic patient developed a blue toe 'out of the blue', as the patient said. There was no history of trauma but a small tissue defect which was painless, and which was the portal of entry for infection.

and sloughy. The wound was irrigated with 2% Milton for 4 days until a wound bed of pink, healthy granulations was present, after which it was cleansed with saline and dressed with a foam dressing. He was discharged after 3 weeks. The foot healed in 6 weeks with minimal scarring; he received follow-up care in the diabetic foot clinic, and ulceration did not recur.

Key points

• Digital necrosis in the neuropathic limb is best treated by toe or ray amputation

• At surgery all necrotic tissue should be removed but sometimes it is difficult to be sure about the viability of all tissue at the operation site

• Thus at the first postoperative dressing, the wound may still contain necrotic and sloughy tissue

• Patients are sometimes taken back to operating theatre for the first change in dressings when further operative debridement can be carried out if necessary

• When postoperative wounds in neuropathic feet are sloughy, Milton irrigation can be used until the wound bed shows healthy granulations

• Milton irrigation does not appear to impair healing of sloughy wounds.

Was this article helpful?

0 0
How To Reduce Acne Scarring

How To Reduce Acne Scarring

Acne is a name that is famous in its own right, but for all of the wrong reasons. Most teenagers know, and dread, the very word, as it so prevalently wrecks havoc on their faces throughout their adolescent years.

Get My Free Ebook

Post a comment