Spontaneous bilateral ankle and midfoot sepsis in a nonimmunocompromised patient.
We describe a 70-year-old nonimmunocompromised woman with spontaneous bilateral ankle and midfoot sepsis and a deep-space abscess of the right lower leg. Salvage of both limbs was achieved by aggressive bilateral soft-tissue and osseous debridement, including a four-compartment fasciotomy of the right lower leg, antibiotic-loaded polymethyl methacrylate bone cement implantation, delayed allogeneic bone grafting of the osseous defects impregnated with autologous platelet-rich plasma bilaterally, and external fixation immobilization, implantable bone growth stimulation, and split-thickness skin graft coverage of the right lower leg, ankle, and foot. Osseous incorporation of the bone grafts bilaterally occurred 8 weeks after surgery. No soft-tissue or osseous complications occurred during the postoperative period or at 18-month follow-up except for arthrofibrosis in the right ankle; there was no evidence of recurrent abscesses, sequestrum, or wound-related problems. A review of the literature regarding bilateral pedal sepsis and the techniques used for limb salvage in this patient are presented in detail.
Weil Foot and Ankle Institute, Des Plaines, IL,USA.
Thomas S
TS
Roukis
Jeffrey R
JR
Baker
Breck
B
Tiernan
D000038:Abscess / Q000382:microbiology / Q000628:therapy*; D000368:Aged; D005260:Female; D005534:Foot Diseases / Q000382:microbiology / Q000628:therapy*; D006095:Gram-Positive Cocci / Q000302:isolation & purification; D006801:Humans; D007121:Immunocompetence; D023821:Limb Salvage / Q000379:methods; D018805:Sepsis / Q000175:diagnosis / Q000382:microbiology / Q000628:therapy*; D013211:Staphylococcus aureus / Q000302:isolation & purification