I have a long question:
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I performed a bunion/hammertoe sx that was very severe problem on a T-2 DM with decreased but adequate circulation. This healed fine and at 3wks removed sutures and looked very good. Then at 3.5wks a small area of dehisence at the 2nd MPJ occured serious fluid but not really any drainage. I cleaned this up and put the patient on omnicef 300 BID. This did not close at 1cm opening and I did use non absorbable sutures at the MPJ capsule. The H.T. was so severe I had to do a mini keller on the base of the 2nd proximal phalanx. He went to a wound clinic and they had him apply betadine and tefa pad which scabbed over. I did debride this at 13 wks, opened it up , probed the area 1 cm and I tried to see the suture but could not. I sent him to a vascular specialist who did an angioplasty, bone-scan and MRI upon which the bone scan came back positive. I did use screw fixation for the bunion. The MRI was inconclusive or poor quality. The vascular doctor had a PICC line installed and patient was started on a 6wk I.V. antibiotics. About a week later he had a indium scan which I think came back positive for osteo. The patient finished his I.V. antibiotics and was started on oral metronidazole 500 BID and omnicef 300mg BID for another 3 months.
My questions are: wouldn't the wound look infected or the foot look infected for a diagnosis of osteo? There was never any purulent exudate, patient never had fever, etc. X-rays did not show signs of osteo. The patient has closed the small dehisence site but I feel he might of been having a reaction to the absorbable suture at 13wks. Would the bone scan be positive from surgery?
Dr Michael E McGowan
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