Oozing puncture wound on foot
A minor foot injury did not prompt our patient to seek treatment. The painful swelling that came later, did.
Aggressive steps were needed for our patient
In the emergency department, we treated our patient with intravenous cloxacillin, gentamicin, and metronidazole. He later underwent surgical debridement and had pus drained from deep abscesses in his foot. Intraoperative findings indicated that there was necrotic tissue involving 80% of the dorsum of the foot and the necrosis extended proximally to the ankle and distally to the toes.
Wound cultures grew group B Streptococcus (Peptostreptococcus species) and Bacteroides. He was treated with intravenous amoxicillin and clavulanic acid (IV Augmentin, available in Singapore) and oral metronidazole. An endocrinologist evaluated him and determined that he had diabetes. He was started on insulin.
Postoperatively, our patient remained septic. Five days later, he underwent a below-the-knee amputation; the surgeons noted that his foot was gangrenous.
Our patient stayed in the hospital for 7 more days and was discharged about 2 weeks after his arrival at the ER.
Correspondence
Ramesh Subramaniam, MBBS, National University Hospital, 5 Lower Kent Ridge Road, Singapore 119074
