Fifty-eight chronic nonhealing foot wounds (51 patients) were treated with irrigation, aggressive debridement, and primary tension-free closure. Factors such as wound location, wound size, presence of infection, and healing outcome were recorded. In addition, medical comorbidities and preoperative laboratory test results were reviewed. Thirty-seven (64%) of the 58 wounds healed after primary closure. Of the other 21 wounds, 16 healed after repeat irrigation, debridement, and closure or local wound care; 2 patients were lost to follow-up after initial failed wound healing, 1 patient died after initial failed wound healing, and 2 cases were salvaged with amputation. Failed primary closures were thought not to increase wound size; all but 3 of these closures decreased wound size significantly. Differences between the wounds that healed primarily and the wounds that failed healing were not statistically significant. Diabetes was present in 46% of the patients whose wounds healed primarily versus 71% of the patients whose wounds failed healing (P = .06). Irrigation, debridement, and primary closure of nonhealing foot wounds can be a useful treatment option for most such patients. Complete healing or reduced wound size occurs in 95% of cases.
Fourteen patients with Lisfranc injuries were treated with open reduction and internal fixation with PLA absorbable screw fixation by a single surgeon. From one to four PLA screws were used in each case (average two). In four patients, K-wires were inserted and removed at six weeks following surgery for instability of the fourth and/or fifth tarsometatarsal joints. Average follow-up was 20 months (range, three to 45 months). No patient was noted to have a soft tissue reaction to the screws. No evidence of osteolysis was noted on any of the follow-up X-rays at the screw sites. No loss of reduction was noted in any follow-up X-rays compared to immediate postoperative radiographs. The use of absorbable screws in this small series was found to be safe, without reaction and obviated the need for screw removal at short-term follow-up.
