PMC3284275_01
Pre-operative radiographic (a, b) and clinical (c) pictures showing the full-thickness ulceration with fibrogranular base and bone exposure in a patient with a left Charcot foot osteomyelitis. The patient underwent ulcer and bone excision with soft tissue and bone cultures and bone biopsy. The histopathological analysis was positive for osteomyelitis of the first metatarsal base, and a revisional surgical debridement was performed with the insertion of cemented antibiotic-impregnated beads (d). The patient was brought back to surgery 6 weeks later for removal of the cemented antibiotic beads, further surgical debridement, and final wound closure. Intra-operative picture of the abductor hallucis muscle flap harvesting (e) and rotation proximally and superiorly over the medial column defect (f). This exposed muscle was covered by the application of a split-thickness skin graft and secured with a bolster dressing. An off-loading circular external fixator was also applied for strict non-weight-bearing, flap monitoring, and stabilization of the left lower extremity (g). Final radiographic (h, i) and clinical (j, k) pictures at 11 months post-operatively, following gradual transition to a walking boot, and finally custom-molded extra depth shoes. The patient continued to ambulate without further infection, collapse, or skin breakdown.
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This constellation of clinical and diagnostic imaging findings were most consistent for Charcot midfoot neuroarthropathy superimposed with osteomyelitis (Fig. 1). At 11 months post-operatively, the patient continued to ambulate well without further infection, collapse, or skin breakdown (Fig. 1).