This case involves a fifty-six-year-old female patient who was suffering from a Charcot foot manifestation with a complete collapse of the arch on the left foot. The patient developed a grade one plantar ulcer and required surgery to reconstruct the foot. The patient underwent extensive surgery that included the removal of non-viable bone, bone grafting, and selective bone fusions. After surgery, the patient displayed further deformity of the foot including significant narrowing of the articulation between the navicula and cuneiform bones. She also sustained aseptic necrosis of the tarsal bone and the medical records fail to show any treatment given to arrest the infectious process. The lack of treatment led to a complete breakdown of the foot and allowed for the spread of fatal osteomyelitis in a diabetic patient.
Question(s) For Expert Witness
- 1. What methods during surgery must be done to arrest the progression of osteomyelitis?
Expert Witness Response E-000228
To arrest infection in osteomyelitis, it is necessary to provide adequate soft-tissue coverage. Over small, soft-tissue defects, a split-thickness skin graft may be placed, whereas large soft-tissue defects may be covered with local muscle flaps and free vascularized muscle flaps. Rotation of a local muscle with its neurovascular supply must be possible anatomically for that procedure to be successful. These flaps bring in a blood supply, which is important for host defense mechanisms, new bone regeneration, delivery of antibiotics, and healing. They also may be used in combination with antibiotics and surgical debridement of necrotic and infected tissues.