Patient Contracts Fatal Infections After Foot Amputation

Case Overview

This case involves an overweight, elderly female patient with a history of poor circulation and diabetes. She presented to her podiatrist with non-healing foot ulcers and was referred to vascular surgery for revascularization. The patient received angioplasty and stent treatment as well as antibiotics and was discharged. The patient returned to the hospital several days later and was found to have gangrene and infection around the tissue of her nails. Podiatry obtained cultures which grew multi-drug-resistant bacteria. The patient underwent surgical intervention to amputate her right foot and was discharged. The patient returned to the hospital a week later with a high fever and a rash on her legs and was diagnosed with atypical measles syndrome. The patient deteriorated significantly during this stay. Non-healing at the amputation sites mandated bilateral below the knee amputation but the patient succumbed to pneumonia shortly after the amputation. An expert in podiatry was sought to review the facts and discuss the standard of care in this case.

Questions to the Podiatry expert and their responses

Please describe your background as it relates to this case. How often do you care for patients with similar health profiles?

I have worked in a wound care center for 8+ years. I also do hospital consults on similar patients with similar conditions. It is common to have patients with wounds that also have several systemic and co-morbid conditions.

What is the standard of care in terms of consulting an infectious disease specialist?

The standard is to assess the severity of the infection and weigh the benefits of early vs. delayed intervention. For an infectious disease specialist to become involved, cultures must be obtained to determine the correct antibiotic usage. The patient would have likely been placed on empiric antibiotics prior to the culture results regardless of health status. The key is for appropriate management when infection occurs.

What is the standard surgical procedure to manage a patient requiring toe amputation and revascularization of the lower extremity?

If the limb becomes ischemic, even if re-vascularization is performed, an infection can set in quickly, especially in a patient with multiple co-morbid conditions. There are several scenarios that can determine when amputation is appropriate before re-vascularization and vice versa. If there is a severe limb or life-threatening infection, the tissue must be removed regardless of circulatory status. If the patient is stable and/or the gangrene is dry, then re-vascularization should be performed prior to amputation. Even then, the blood flow should be re-assessed to determine the proper level of amputation to maximize the chances of healing.

About the expert

This expert has over 20 years of experience in the field of podiatric medicine. He earned his BS and his DPM from the Dr. William Scholl College of Podiatric Medicine. He completed his residency in primary podiatric medicine at the North Chicago Veterans Administration Hospital and his podiatric surgical residency at St. Joseph Hospital. Today, this expert is board certified in reconstructive rearfoot and ankle surgery as well as foot surgery. He is a member of the American College of Foot and Ankle Surgeons, the American Board of Podiatric Surgeons, and the American Podiatric Medical Association. This expert previously served as a foot and ankle surgeon at Lansing Orthopedic. Most recently, he was an assistant professor of osteopathic surgical specialties at Michigan State University, a foot and ankle surgeon at their affiliated medical center, and the section chairman of podiatry at Mclaren Orthopedic Hospital. Currently, he serves as a foot and ankle surgeon at an orthopedic hospital in Michigan.

E-054072

Specialties:

Podiatry

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