How To Manage Traumatic Wounds Successfully

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This patient sustained an open crush injury to the talus when a railroad beam fell on his foot. Lawrence DiDomenico, DPM, says it is more common to see open fractures of the phalanges with crush injuries. (Photo courtesy of Robert Mendicino, DPM, and Alan
Here is a view of a split thickness skin graft in a non-weightbearing area. However, when it comes to plantar wounds, Dr. Grossman says split thickness skin grafts are often unable to withstand the forces required by prolonged weightbearing.
How To Manage Traumatic Wounds Successfully
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Author(s): 
Clinical Editor: Lawrence Karlock, DPM

   While he notes he is not adept with plastic surgery techniques, Dr. Spitalny will not hesitate to consult a plastic surgeon but does not turn cases over to the plastic surgeon.

    “Plastic surgeons are excellent consultants but we are far more capable of managing foot and ankle wounds,” emphasizes Dr. Spitalny. “If they know you are capable of managing such wounds, I assure you they will send it your way.”

   Dr. Spitalny says he will ask for a plastic surgeon’s assistance on a free muscle graft or rotational flap. However, he does not see much value in plastic surgery until wounds are clean and viable and fractures have been stabilized. He adds that rotational flaps, skin expanders or even skin grafts have little place early in treatment.

   However, Dr. Spitalny emphasizes that the early use of negative pressure wound therapy (VAC, KCI) has “simply revolutionized trauma surgery.” Lawrence Karlock, DPM, concurs about the efficacy of the VAC, saying it promotes granulation tissue over deep exposed tendon and allows for more definitive coverage of soft tissue.

Dr. DiDomenico is a Fellow and member of the Board of Directors of the American College of Foot and Ankle Surgeons. He is a Diplomate of the American Board of Podiatric Surgery and an Adjunct Professor at the Ohio College of Podiatric Medicine. He is the Director of the Reconstructive Rearfoot & Ankle Surgical Fellowship at the Ankle and Foot Care Centers at the Ohio College of Podiatric Medicine.

Dr. Grossman is Chief of the Section of Podiatry at the Akron Medical Center in Akron, Ohio. He is a Fellow of the American College of Foot and Ankle Surgeons and a Diplomate of the American Board of Podiatric Surgery.

Dr. Spitalny is a staff podiatrist at St. Mary’s Duluth Clinic in Duluth, Minn. He is a Fellow of the American College of Foot and Ankle Surgeons and a Diplomate of the American Board of Podiatric Surgery.

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.

Editor’s note: For the first part of this discussion, please see the September 2005 issue or check out the archives at www.podiatrytoday.com.

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