Reference no: EM131557309

The patient was brought to the operative suite where general LMA anesthesia was induced. The lower leg and foot were widely prepped and draped in sterile fashion. The patient had an extensive area of gangrene involving the dorsum of the left foot. The 3rd and 4th toes were completely gangrenous, and the skin above and on the plantar aspect of the 2nd toe was gangrenous as well. A sharp incision was used to remove all dead tissue at the line of demarcation of what was alive and what was not. The underlying 2nd, 3rd, and 4th metatarsals were involved. The infection was transected somewhat proximally, necessitating complete removal of the 2nd, 3rd, and 4th toes. A portion of the skin of the plantar aspect of the foot was debrided, because the skin was also nonviable. Fortunately, there was good bleeding at the margins of the wound once the necrotic tissue was fully debrided. This was controlled with electrocautery and l-0 Vicryl LigaSure. The wound was copiously irrigated. Our intention was to treat this initially with a wound vac, but because there was bleeding that was worsened with application of wound vac, this was abandoned, and the patient was treated with Surgicel followed by sterile gauze fluff dressings and an Ace wrap. Throughout the procedure, estimated blood loss was approximately 150 mL. She was transported to the recovery room in overall stable condition and tolerated the procedure well.