Posted: Jul 8 2016 #(C2627)

Open injury of the dorsal surface of the forefoot ( exposed tendon and 1st MTP joint)

}

HPI

The patient reported an injury of the right forefoot ( her foot caught in the wheel of the quadbike) and she presented 10 hours after the incident

PMH

Free, unremarkable , No history of known allergies

Extremity neurovascularly intact. The x-ray survey didn't reveal any fracture or dislocation

Poll

1 of 8

In light of the fact that the tendon and joint are exposed, how would you treat this wound?

1 Secondary healing (frequent dressing changes to get bed of granulation tissue)

2 Primary coverage with skin graft

3 Primary coverage with flap

Other

Submit

P: 9087

Would you attempt primary closure of 1st MTP joint with local soft tissues and joint capsule?

1 Yes - Primary closure 1st MTP joint capsule after I&D

2 No - I would leave joint capsule open to minimize risk of a septic arthritis and close it in a stage fashion

Other

Submit

P: 9088

If you chose secondary healing with frequent wound care, how frequently would you changes the dressing?

1 Every other day

2 Daily

3 BID (twice a day)

4 TID (three times a day)

Other

Submit

P: 9091

If you choose secondary healing with frequent dressing changes, what type of solution would you use to irrigate the wound?

1 None (dressing changes alone without irrigation)

2 Local tap water from sink

3 Sterile water (normal saline)

4 Saline mixed with betadine solutions (10%)

5 Saline mixed with antibiotics

Other

Submit

P: 9092

If you choose secondary healing with frequent dressing changes, what type of DRESSING would you use to cover the wound? Take into consideration that your are in a remote location with limited resources?

1 Vaseline gauze soaked in betadine solution 10%

2 Vaseline gauze soaked in 15% NaCI solution

3 Vaseline gauze with silver sulfadiazine ointment

4 Vaseline gause with honey (manuka)

5 Curlex dressing (4x4) soaked in betadine solution 10%

6 Curlex dressing (4x4) soaked in 15% NaCI solution

7 Curlex dressing (4x4) soaked in local sink water

Other

Submit

P: 9095

While not available in this location, do you think this would would benefit from a Wound Vac?

1 Yes

2 No

Other

Submit

P: 9096

In addition to tetanus, What would be your approach to antibiotics for this wound?

1 No antibiotics

2 Oral antibiotics for several weeks

3 Initial dose of IV Antibiotics at presentation then stop

4 Continued IV antibiotics in hospital until tendon and joint are covered

5 Initial dose of IV Abx then oral antibiotics until tendon and joint are covered

Other

Submit

P: 9097

Sort by

L1\L2 Evidence

Date