Debridement of Soft Tissue Infections of the Foot and Ankle



Debridement of Soft Tissue Infections of the Foot and Ankle


Hunter S. Oliver-Allen

Michael C. Holland

Scott L. Hansen





ANATOMY



  • The lower leg, ankle, and foot comprise 28 bones.


  • Soft tissues include muscles that are divided into anatomically distinct compartments in both the lower leg and the foot (FIG 1).



    • The four compartments of the lower leg include the anterior, lateral, superficial posterior, and deep posterior divided by fascia.


    • The nine compartments of the foot include the calcaneal —communicating with the deep posterior compartment of the leg, superficial, medial, lateral, adductor, and four interosseous.






      FIG 1 • Cross section of the leg showing the compartments. (From Pansky B, Gest TR. Lower limbs. In: Lippincott’s Concise Illustrated Anatomy: Back, Upper Limb, and Lower Limb. Vol. 1. Baltimore, MD: Wolters Kluwer; 2012:198.)



  • The primary neurovascular structures include the anterior tibial, peroneal, and posterior tibial arteries and paired veins; superficial peroneal, deep peroneal, tibial, saphenous, and sural nerves; and greater and lesser saphenous veins in the superficial tissues.


  • Plantar surface is composed of thick glabrous epidermis and dermis, and a subcutaneous layer with vertical fibrous septae, densely adhering it to the plantar fascia and periosteum.


PATHOGENESIS



  • Infections result from breakdown of natural defenses in skin such as with trauma or open wound and invasion of resident skin flora or environmental pathogens.1


  • Patients with neuropathy and vascular disease and are immunocompromised have increased risk of infection.1


  • Group A beta-hemolytic streptococcus is the most common and second most common is Staphylococcus aureus.


  • Infections are also commonly polymicrobial, especially in diabetic patients.


  • NSTI result from bacterial invasion and subsequent angiothrombosis decreasing blood supply causing tissue necrosis They are classified into two groups:2



    • Type I is a polymicrobial infection consisting of anaerobic bacteria and aerobic bacteria.


    • Type II is monomicrobial infections typically of group A streptococcus or other beta-hemolytic streptococcus alone or with other pathogens.

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Nov 24, 2019 | Posted by in Aesthetic plastic surgery | Comments Off on Debridement of Soft Tissue Infections of the Foot and Ankle
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