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Use of a Surgical Preparation and Sterile Dressing Change During Office Visit Treatment of Chronic Foot and Ankle Wounds Decreases the Incidence of Infection and Treatment Costs

Department of Surgery, Madigan Army Medical Center, Tacoma, Washington

Thomas S. Roukis, DPM, FACFAS

Department of Surgery, Madigan Army Medical Center, Tacoma, Washington, thomas.s.roukis{at}us.army.mil

Foot and ankle surgeons work with a patient population burdened by multiple factors that adversely affect wound healing and the ability to combat infection. As a result, many of these patients are seen for treatment of chronic ulcerations on their lower extremities that are highly susceptible to colonization and possible progression to a limb- and/or life-threatening infection. The Limb Preservation Service at the Madigan Army Medical Center hypothesized that implementation of a standardized protocol involving a formal physician-directed surgical preparation of the affected lower extremity and a physician-applied sterile dressing at each outpatient clinic appointment would reduce the incidence of infection, use of systemic antibiosis, and thus the requirement for frequent follow-up office appointments. Initiation of this protocol resulted in the reduction of infection to the extent that antibiotic need was eliminated. The frequency of office visits required for follow-up was also significantly reduced. This is key in treating a patient population in which the financial burden to treat chronic wounds and associated infections represents a large portion of the health care money spent for their medical care.

Key Words: foot and ankle surgery • diabetes • high-risk surgical patient • surgical preparation • postoperative infection • limb preservation

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