Management Of Crush Injuries Of The Foot.
Prophylactic parenteral antibiotic use consisting of cefazolin and gentamicin began in the emergency department. Additionally, the patient received tetanus prophylaxis. After discussing all possible treatment options with the patient, we agreed to proceed with a transmetatarsal amputation. The patient presented to the emergency department having had nothing by mouth (NPO) since dinner the evening before, which allowed him to go to surgery within several hours of the injury. We thoroughly debrided the wound and flushed it intraoperatively with copious amounts of normal sterile saline. The lead surgeon felt there was enough healthy skin to perform a primary closure. We left a Penrose drain in place to allow drainage over the next several days. The patient stayed overnight in the hospital for observation and was discharged home the next day.
At a subsequent follow-up in the office, the patient demonstrated multiple fracture blisters to the dorsum of his foot. The incision site remained intact with some necrotic changes to the dorsal and lateral aspect. The fracture blisters had drainage and cleansing with betadine. We will continue to monitor the patient closely over the next several weeks to months until complete resolution of his wounds occurs.