Posters
Presenting Author Academic/Professional Position
Faculty
Academic Level (Author 1)
Faculty
Discipline/Specialty (Author 1)
Surgery
Academic Level (Author 2)
Faculty
Discipline/Specialty (Author 2)
Surgery
Academic Level (Author 3)
Faculty
Discipline/Specialty (Author 3)
Surgery
Presentation Type
Poster
Discipline Track
Clinical Science
Abstract Type
Case Report
Abstract
Background: Severe necrotizing diabetic foot infections are known to have high morbidity, high amputation risk, and high complication rates. Efforts at preserving the limb require significant surgical efforts and lengthy wound care. This process is more complicated in patients with significant housing instability.
Case Presentation: A 53-year-old male with uncontrolled diabetes (A1c 7.9%), housing insecurity, food insecurity presented with severe necrotizing diabetic foot infection with ascending cellulitis, infectious hemorrhagic bullae, multi-compartment abscesses of the foot and anterior leg. It is known that patients with diabetes are at increased risk of both amputation and surgical interventions than patients without diabetes. This patient underwent aggressive surgical intervention to avoid primary below knee amputation.
Serial debridement and interval amputations were performed of the right foot to eradicate multiple sinus tracts of draining, heavy purulence > 200 cc. The patient was maintained on IV antibiotics. Following infectious containment and forefoot amputation, and complete loss of the dorsal soft tissue envelope, the decision to proceed with limb salvage was continued with serial grafting and close monitoring. The forefoot amputation site was remodeled surgically, and the soft tissue defect was primed with acellular wound particulate graft*. With satisfactory clinical response, surgery #4 was performed with an antimicrobial fetal bovine dermal repair scaffold** due to the complicated nature of injury, initial degree of soft tissue compromise exposing bone, and social factors.
Conclusion: The bovine dermal scaffold contributed to expedited wound healing with reduction in wound depth from bone to near complete leveling in 12 days. Following initial hospitalization and surgical intervention, outpatient wound care was continued until split thickness skin grafting was performed. The wounds remain closed with skin turgor and tone of above standard integrity and the patient maintained a functional limb. The patient remains ambulatory more than 18 months postoperatively.
In severe diabetic foot infections with sepsis, necrotizing soft tissue infection, and multi-compartment involvement, aggressive surgical intervention and clear goals of care are essential to expedite treatment, reduce hospital length of stay, and manage expectations. The complexity of maintaining a functional foot can initially obscure treatment goals.
This case highlights successful limb salvage through podiatric surgical interventions, infection, control, soft tissue management, and split-thickness skin grafting in the setting of housing insecurity to facilitate rapid healing.
Recommended Citation
Campbell, Stephanie N.; Killeen, Amanda; and Sobolevsky, Michael, "Successful Limb Salvage in a Severe Diabetic Foot Infection: A Case Study of Aggressive Surgical Intervention and Grafting Technique" (2025). Research Symposium. 183.
https://scholarworks.utrgv.edu/somrs/2025/posters/183
Included in
Endocrinology, Diabetes, and Metabolism Commons, Podiatry Commons, Wounds and Injuries Commons
Successful Limb Salvage in a Severe Diabetic Foot Infection: A Case Study of Aggressive Surgical Intervention and Grafting Technique
Background: Severe necrotizing diabetic foot infections are known to have high morbidity, high amputation risk, and high complication rates. Efforts at preserving the limb require significant surgical efforts and lengthy wound care. This process is more complicated in patients with significant housing instability.
Case Presentation: A 53-year-old male with uncontrolled diabetes (A1c 7.9%), housing insecurity, food insecurity presented with severe necrotizing diabetic foot infection with ascending cellulitis, infectious hemorrhagic bullae, multi-compartment abscesses of the foot and anterior leg. It is known that patients with diabetes are at increased risk of both amputation and surgical interventions than patients without diabetes. This patient underwent aggressive surgical intervention to avoid primary below knee amputation.
Serial debridement and interval amputations were performed of the right foot to eradicate multiple sinus tracts of draining, heavy purulence > 200 cc. The patient was maintained on IV antibiotics. Following infectious containment and forefoot amputation, and complete loss of the dorsal soft tissue envelope, the decision to proceed with limb salvage was continued with serial grafting and close monitoring. The forefoot amputation site was remodeled surgically, and the soft tissue defect was primed with acellular wound particulate graft*. With satisfactory clinical response, surgery #4 was performed with an antimicrobial fetal bovine dermal repair scaffold** due to the complicated nature of injury, initial degree of soft tissue compromise exposing bone, and social factors.
Conclusion: The bovine dermal scaffold contributed to expedited wound healing with reduction in wound depth from bone to near complete leveling in 12 days. Following initial hospitalization and surgical intervention, outpatient wound care was continued until split thickness skin grafting was performed. The wounds remain closed with skin turgor and tone of above standard integrity and the patient maintained a functional limb. The patient remains ambulatory more than 18 months postoperatively.
In severe diabetic foot infections with sepsis, necrotizing soft tissue infection, and multi-compartment involvement, aggressive surgical intervention and clear goals of care are essential to expedite treatment, reduce hospital length of stay, and manage expectations. The complexity of maintaining a functional foot can initially obscure treatment goals.
This case highlights successful limb salvage through podiatric surgical interventions, infection, control, soft tissue management, and split-thickness skin grafting in the setting of housing insecurity to facilitate rapid healing.
