Question
Dear Dr. Katz:
On June 21, 2010 I underwent a triple arthrodesis on my right foot.  The surgery was done in southern Maine by Dr. Greg Pomeroy, a great surgeon.  I was 9 weeks in a cast with total bed with foot elevated, and limited bathroom visits.  I had developed a couple of wounds on the foot, when the final cast was removed.  Is this normal for incision wounds to develop?  Is it because the staples were removed too early?  I never put any weight on my foot, as I would hop around with a walker.  I am now back in Florida, nursing the wounds with Santyl gel, per direction of a wound care doctor in Leesburg, Fl.  I walk with an aircast boot to alleviate the weight on the foot.  One wound, which was on the right ankle, has healed to a point where we don't have to put Santyl on it anymore.  The other wound, which is situated about 3 inches below the big toe, is a bit more stubborn.  Yellow slough keeps forming, so Dr. Weber debrides it every week.  He does seem very knowledgeable about wound care.  I guess we have to give these wounds their proper time to heal.  We can't will them to hurry up.  Is Santyl a good healing gel, or is there something else out there that would speed up the healing process.  Thanks for any answers you can provide me.

Answer
Hi Judy,

After this surgery it is not unusual to have some wounds after the cast is removed.  This can happen even if the stitches or staples are removed at the correct time.  

The best treatment for wounds is aggressive weekly debridement.  However, if the wounds are slow healing there need to be more advanced healing techniques and Santyl is not considered advanced.  Some people require skin graft, a product called Apligraf or a device known as a wound vac.  I would not let these linger for too long without healing.  Although, I cannot make a proper judgement without actually seeing the wounds.

Sincerely,


Marc Katz, DPM
Tampa, FL
Advanced Podiatry

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