Residency Insight - A PRESENT Podiatry eZine
Residency Insight -- A PRESENT Podiatry eZine

 
Ryan Fitzgerald, DPM
Ryan Fitzgerald, DPM
PRESENT Associate Editor
Hess Orthopedics &
Sports Medicine,
Harrisonburg, Virginia
Complex Soft Tissue Trauma:
The Podiatric Surgeon’s Role in Traumatic Limb Salvage

Complex soft tissue trauma presents the podiatric physician with a unique and challenging opportunity for patient care. In addition to soft tissue deficits, patients who have sustained complex soft tissue injuries often present with concomitant osseous injuries, and it is necessary to stabilize any concomitant fractures in conjunction with any reconstructive efforts.  Commonly, A multidisciplinary team approach allows for expeditious evaluation and treatment of the acute trauma patient in the hospital setting and allows the various surgical and medical specialties the opportunity to provide insight into the appropriate patient management.  It is important to realize that patients suffering from significant soft tissue loss injures may have associated severe life-threatening injuries, and the initial evaluation of these patients must begin with an assessment of the ABCs (Airway, Breathing, and Circulation) as part of an appropriate primary survey.

Figure 1

xray
It is prudent to begin by obtaining a thorough event history including, but not limited to, questions regarding the mechanism of action of the injury, the age of the injury, previous attempts at treatments, and any clothing or shoe-gear worn during injury.  It is also important to obtain a current medical history for the patient including any previous medical conditions, current medications, a social history including tobacco or drug use, any known drug allergies, and the patient’s tetanus immunization status

When making the determination regarding potential limb salvage attempts, one must weigh the risks and benefits.  Following complex soft tissue injury, it is essential that the patient be returned to some level of functional status either through reconstruction or amputation.  In some cases, such as mutilating injuries, amputation is the definitive procedure of choice.

Figure 2

Apart from surgical concerns, patients suffering complex soft tissue trauma present unique medical management challenges.  These patients demonstrate increased risk for DVT and PE formation, which can have significant morbidity and mortality if not addressed, and it is essential that this patient population receive appropriate anticoagulation therapy.  Furthermore, there are a number of medical conditions that hinder wound healing, and any modifiable systemic or local factors must be addressed to ensure the most healthy wound bed available to encourage wound healing.

Conclusion:

Considering the significant and broad-spectrum management required for patients suffering from complex soft tissue trauma, it is important to recognize and utilize all the resources available, such as nutritionist and plastic surgery consultations.  A multidisciplinary approach to patient care provides the patient with the highest level of care and the greatest chance for success.

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