Surgical Management of Foot Infections

Question 1

What are good history questions to ask?

Answer 1

Onset and duration
Trauma
Contamination
Pain
Last ate or drank

Question 2

ROS questions

Answer 2

F/C/N/V
Recent blood glucose

Drug allergies

Question 3

Things to look for on x-ray

Answer 3

Gas
Foreign bodies
Osteo

Question 4

Wound without purulence or any manifestations of inflammation

Answer 4

Uninfected

Question 5

Cellulitis or erythema 0.5-2cm around area.
Limited to skin or superficial subcutaneous.
No local or systemic complications

Answer 5

Mild

Question 6

Erythema greater than 2cm or involving deep structures

NO SIRS

Answer 6

Moderate

Question 7

Local infection WITH SIRS

Answer 7

Severe infection

Question 8

SIRS is manifested by greater than or equal to 2 of the following:

Answer 8

Temp >38, <36
HR >90
RR>20
PaCO2 <32
WBC >12, <4

Question 9

Thick, yellow, and purulent drainage infection

Answer 9

MSSA

Question 10

Infection with quicker onset of purulent drainage

Answer 10

MRSA

Question 11

Deeper red infection than Staph, not as purulent

Answer 11

Strep

Question 12

Infection with a fruity smell and green tinge

Answer 12

Pseudomonas

Question 13

Infection with a foul smell and brown/watery discharge

Answer 13

Anaerobic

Question 14

What are the main infecting organisms?

Answer 14

Staph and Strep

Question 15

These present clinically on open skin, local redness and edema, extreme pain, palpable fluctuance, and fever

Answer 15

Abscess

Question 16

What are the 4 D’s of abscess treatment?

Answer 16

Decompression
Drainage
Debridement
Drugs

Question 17

When should surgical I&D be done?

Answer 17

Within 1-2 days

Question 18

Should antibiotics be given for abscess treatment?

Answer 18

IV in hospital until signs of infection are gone

Orally upon discharge

Question 19

Most common OM in podiatry?

Answer 19

Direct extension

Question 20

What is the most common type of gas producing infection seen in DM patients?

Answer 20

Nonclostridial myonecrosis/nec fas such as GBS

Question 21

Describe the presentation of nonclostridial myonecrosis/nec fasc

Answer 21

Slower developing
Skin changes from bronze to blue/back then to hemorrhagic bulla

Sharper/acidic odor

Question 22

Nonclostridial myonecrosis antibiotic treatment

Answer 22

Empiric until gram stain back

Surgically debride ASAP

Question 23

Clostridial presentation

Answer 23

Sudden onset w/ severe pain
Heaviness
Low grade fever
Skin changes from bronze to blue/black to hemorrhagic bulla
Non-odorous or sweet
Crepitus
Pain is SEVERE

Question 24

Clostridial treatment

Answer 24

Penicillin
Aggressive debridement
HBO therapy

Question 25

Surgical keys for Gas infections

Answer 25

Get to the OR
Aggressive debridement
Leave open
Take back to OR