Post-Surgical Complications Lead to Severe Wound Management Challenges

Case Overview

This case involves an adolescent who presented with persistent toe pain and subsequently underwent a left foot lapidus bunionectomy along with an akin osteotomy. During the first post-operative visit, the podiatrist observed small superficial bullae along the central incision site. In response, they opted to lance the bullae, revealing serous fluid beneath. Unfortunately, the condition escalated, leading to the development of open wounds characterized by necrosis. Additionally, an ulcer formed on the medial foot, exposing bone tissue. The patient was ultimately diagnosed with osteomyelitis, necessitating extensive wound care management, which included multiple debridement treatments, a surgical skin flap procedure, and partial excisions of the first metatarsal base and distal first metatarsal.

Questions to the Wound Care expert and their responses

How often do you evaluate and manage patients who have been diagnosed with superficial bullae?

I manage patients who have been diagnosed with superficial bullae on a regular basis and routinely perform diagnostic tests and evaluations to determine the etiology of the bullae so as to treat them appropriately.

What are the most pertinent measures that wound care physicians can perform to optimize recovery for patients with superficial bullae?

It is imperative to understand the exact cause of the bullae as this will drive the specific treatment plan. If they are due to infection, debridement and antibiotics may be necessary. If they are due to ischemia, vascular intervention may be necessary. If they are to due autoimmune issues, treatment with steroids may be needed.

About the expert

This expert has nearly 10 years of experience in the field of wound management. He earned his BA in Neurobiology from the University of Pennsylvania and his MBA in healthcare management from St. Joseph's University, followed by his DO from the Philadelphia College of Osteopathic Medicine. He then completed both an internship and residency in surgery and a fellowship in vascular surgery, all at Pennsylvania Hospital. Today, this expert is a certified wound specialist physician and is an active member of several professional organizations such as the American College of Surgeons, the Society for Cardiovascular Magnetic Resonance, and the American Osteopathic Association. He frequently presents on topics in wound care and has also published several articles. Currently, he is an attending physician, a senior physician lead, and an assistant medical director at a wound care specialty group in Pennsylvania. In addition, he is a research specialist at an Ivy League university and the chief medical advisor for a rehabilitation center, also located in Pennsylvania.

E-433475

Specialties:

Wound Care