Cath Lab Digest

Q: Any thoughts about operating in the face of fracture blisters?
A: Dr. Ray says he prefers not operating through bullae, especially if they are hemorrhagic. Instead, he immobilizes the site to prevent further soft tissue trauma. He elevates and cools the limb, saying ice or a cooling unit can prevent swelling. Employing a sequential compression device will facilitate removal of edema from the limb and you can unroof the bullae, according to Dr. Ray. Then you would manage the wound to promote epithelialization.
Dr. Cicchinelli concurs. When treating fracture blister patients, he says you can put the “vast majority” of them in splints and Jones compression dressings. Then he suggests scheduling them for a follow-up visit 10 days to two weeks later and continuing to optimize the skin/wound environment.
Dr. Cicchinelli says he will only operate if the patient has an open fracture or neurovascular compromise, and the risk of infection is equal or greater to the possibility of wound compromise from the fracture blisters.

Q: What other suggestions do you have on using VAC therapy for postoperative wound problems?
A: While he has limited experience in using VAC therapy for post-op wounds, Dr. Karlock says the adjunctive modality has a role for the draining, well vascularized postoperative wound. He says he would avoid using this modality in a partially ischemic wound that is fragile and prone to pressure breakdown.

Dr. Cicchinelli has a private practice at Eastern Carolina Foot and Ankle Specialists, Inc. in Greenville, N.C., and is a faculty member of the Podiatry Institute.

Dr. Ray has a private practice at the Foot and Ankle Clinic of Montana in Great Falls, Mt., and is a Fellow of the American College of Foot and Ankle Surgeons.

Dr. Karlock (pictured) is a Fellow of the American College of Foot and Ankle Surgeons and practices in Austintown, Ohio. He is a member of the Editorial Advisory Board for WOUNDS, a Compendium of Clinical Research and Practice.