Expert Insights On Managing Traumatic Wounds

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Author(s): 
Clinical Editor: Lawrence Karlock, DPM

Crush injuries, as well as anything to do with motorcycle injuries, are Dr. McCord’s most challenging traumatic wounds. He cites a 16-year-old patient who went down in a motorcross race when another motorcycle slammed down on his foot and ankle. He had six fractures plus soft tissue trauma but no lacerations, and the foot had all of the characteristics of an explosive injury. As Dr. McCord says, the patient is finally doing well and is in physical therapy to regain range of motion and strength. He has also regained sensation that had been lost for three weeks.

An important aspect of treating trauma is getting a good history and understanding the physics of the injury, according to Dr. McCord. To understand the extent of the injury, he says DPMs need to remember the old physical formula of F=ma (force equals mass times acceleration).

Dr. Spitalny tries not to utilize topical dressings with traumatic wounds. He notes that he only uses VAC therapy with silver dressings such as Xeroform, Adaptic or Mepitel. He confesses to being “old fashioned” in that he will pack contaminated wounds with Betadine soaked gauze.

For Dr. Judge, non-adherent superficial dressings are the hallmark for traumatic wounds and one may subsequently apply sterile compression dressings as appropriate.

Dr. Judge is a Fellow of the American College of Foot and Ankle Surgeons. She completed a three-year surgical residency program in major reconstructive surgery for the leg, foot and ankle. She is board-certified in reconstructive rearfoot and ankle surgery. She has offices in Port Clinton, Ohio and Lambertville, Mich.  

Dr. McCord is a Diplomate with the American Board of Podiatric Surgery. He practices at the Centralia Medical Center in Centralia, Wash.

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 is a Fellow of the American College of Foot and Ankle Surgeons, and practices in Austintown, Ohio. He is the Clinical Instructor of the Western Reserve Podiatric Residency Program in Youngstown, Ohio. Dr. Karlock is a member of the Editorial Advisory Board for WOUNDS, a Compendium of Clinical Research and Practice.

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