ABSTRACT
We reviewed 33 patients with 37 wounds treated between November of 1991 and December of 1995 in the Wound Care Center. A two-stage debridement and closure technique for neuropathic foot ulcers was performed. Patients selected included those with obvious osteomyelitis and those who had failed nonsurgical treatment. The approach included initial surgical excision of the ulcer with biopsy, bone resection with biopsy, and deep culture. The second-stage procedure 4 to 8 days later included debridement of the wound and delayed closure. Intravenous antibiotic treatment using a central line was given postoperatively in patients with documented osteomyelitis for at least 6 weeks and in patients with infected soft tissues only for about 4 weeks. All patients remained nonweightbearing for 4 weeks; this was felt necessary to prevent separation of the wound edges. Four wounds in four patients failed to heal, and two of these went on to amputation. Satisfactory healing occurred in 29 of 33 patients and in 33 of 37 wounds. The authors conclude that two-stage surgical debridement and closure is an acceptable treatment in selected nonhealing diabetic (neuropathic) foot ulcers.
Subject(s)
Debridement/methods , Diabetic Foot/surgery , Suture Techniques , Adult , Aged , Aged, 80 and over , Chronic Disease , Diabetic Foot/complications , Diabetic Foot/physiopathology , Female , Humans , Male , Middle Aged , Osteomyelitis/etiology , Osteomyelitis/surgery , Retrospective Studies , Time Factors , Wound HealingABSTRACT
Brain abscess caused by Pseudallescheria boydii is a highly lethal infection, usually seen in immunosuppressed patients. Five patients with P. boydii brain abscesses are described. Four of these patients acquired their infection after near-drowning; 1 patient developed an abscess after penetrating head trauma. Two patients survived their infections, which included involvement of other body sites (lung, eye, bone) as well as multiple undrained brain abscesses, after prolonged courses of high-dose parenteral miconazole (80-90 mg/kg/d). Progressive increases in miconazole dosage during the treatment periods were required to produce serum levels above the minimum inhibitory concentrations of the fungal isolates.
Subject(s)
Brain Abscess/etiology , Drowning , Miconazole/therapeutic use , Mycetoma/etiology , Resuscitation , Adult , Brain Abscess/diagnostic imaging , Brain Abscess/drug therapy , Child, Preschool , Female , Humans , Male , Middle Aged , Mycetoma/diagnostic imaging , Mycetoma/drug therapy , Orbit/injuries , Tomography, X-Ray Computed , Wounds, Penetrating/complicationsABSTRACT
Two patients with toxic shock-like syndrome are presented. Both patients had necrotizing cellulitis due to Streptococcus pyogenes, and both patients required extensive surgical debridement. The association of Streptococcus pyogenes infection and toxic shock-like syndrome is discussed.
