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.
Roukis
Thomas S
TS
Weil Foot and Ankle Institute, Des Plaines, IL,USA.
Baker
Jeffrey R
JR
Tiernan
Breck
B
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