TREATMENT OF BILATERAL CHRONIC CALCANEAL WOUNDS ASSOCIATED WITH OSTEOMYELITIS AND INFECTION OF THE LEFT CALCANEAL TENDON USING THE FIGUEIREDO TECHNIQUE IN A DIABETIC PATIENT: A CASE REPORT

Аннотация

INTRODUCTION (FIGURE 3). As the first approach attempted to A 52-year-old male patient with decompensated preserve part of the calcaneal tendon, it was diabetes and severe heart failure. He developed suspected that the infectious focus was in the bilateral chronic wounds on the heels (diabetic residual tendon, so a new approach was required foot) with bone exposure associated with for a more extensive resection. osteomyelitis and infection of the left calcaneal tendon, which had been progressing for 4 months On the second look, signs of loosening of the (FIGURE 1). sutures on the right calcaneal prosthesis were observed and it was decided to replace the He was hospitalized due to the decompensation of prosthesis. In addition, resection of the left his comorbidities as a result of the infectious calcaneal tendon up to the myotendinous condition of his wounds and had severe functional transition was performed due to tissue non- limitations in both lower limbs. viability and the presence of purulent secretion A wide surgical debridement of the wounds, (FIGURE 4). The polypropylene prosthesis in the exploration of the calcaneal tendon and coverage left calcaneal wound was firmly in place, with no with the Figueiredo Technique were proposed loosening of the sutures and good progress in the (FIGURE 2). The patient was kept in hospital for healing process, and it was decided to keep it, with empirical broad-spectrum antibiotic therapy until no need for replacement during this surgical the results of the intraoperative cultures were period. obtained. It was decided to keep the patient in hospital for The result was the growth of a multidrug-resistant another week, until the first external dressing bacterium, Morganela Morganii, and the decision change to observe the surgical wound, which was was made to maintain intravenous antibiotic dry, with no dehiscence, no phlogistic signs and no therapy with Linezolid for 4 weeks, given the outflow of purulent secretion (FIGURE 5). The severe infectious condition and the high risk of patient's comorbidities were completely under decompensation of his comorbidities. control and, at this point, both wounds already had The dressing was changed every 7 days and, after an advanced granulation process, the bony 1 month of treatment, despite the good progress of exposure of the calcaneus was completely covered the wound healing process, there was purulent and there were no signs of periprosthetic secretion coming out of the surgical wound over phlogiston. The patient was then discharged from the left calcaneal tendon and local phlogosis hospital for outpatient follow-up and weekly https://www.theamericanjournals.com/index.php/tajmspr 85 THE USA JOURNALS THE AMERICAN JOURNAL OF MEDICAL SCIENCES AND PHARMACEUTICAL RESEARCH (ISSN – 2689-1026) VOLUME 06 ISSUE12 external dressing changes. Oral antibiotic therapy the biggest cause of lower limb amputations. was maintained for 15 days, with no need to use Today, local wound care, serial dressings and high- antibiotics after that until the end of treatment. cost therapies such as vacuum dressings and hyperbaric oxygen therapy help to control the Outpatient follow-up was carried out with the first progression of these wounds, but are rarely able to return 1 week after hospital discharge, the second lead to complete healing of the lesions.4 at 2 weeks and from then on the patient was followed up once a month, maintaining wound care and external dressings carried out painlessly at Another point is the concomitant bacterial home. infection, which is very common and can affect During the follow-up, a progressive maturation of deep soft tissues, often even the bone, leading to the granulation was observed, with osteomyelitis. In these cases, hospitalizations for epithelialization of the wound occurring intravenous antibiotic therapy, serial surgical centripetally, starting at the edges towards the debridements and often amputations are center (deeper area), gradually reducing the size of necessary to preserve the patient's life.1 the lesion. The operative wound on the calcaneal FT consists of covering the entire lesion with a tendon was completely healed 3 weeks after polypropylene prosthesis sutured to its healthy surgery, in good condition, with no sign of the edges, after extensive debridement to remove all infectious process reactivating (FIGURES 6,7,8,9 necrotic and infected tissue. The technique is and 10). based on the principle of healing by second After 5 months of treatment with the Figueiredo intention in a protected manner, promoting Technique, the wounds were completely healed protection from external aggressions and and the soft tissue infection and osteomyelitis optimizing the inflammatory phase of healing, so resolved (FIGURES 11 and 12), as evidenced by the that the healing process is possible even in an progressive decline and normalization of the organically weakened organism.3 inflammatory tests and imaging exams. In the case