Do wounds with a large fibrogranular base following a 5th ray amputation for gangrene typically require closure weeks or months after treatment with intravenous (IV) antibiotics for residual osteomyelitis?

From the Guidelines

Open 5th ray amputation wounds with fibrogranular bases typically do not require surgical closure weeks or months later. These wounds generally heal by secondary intention, where the body naturally fills the wound with granulation tissue and eventually forms scar tissue. The current treatment plan of IV antibiotics for osteomyelitis, as guided by the iwgdf/idsa 2023 guidelines 1, followed by outpatient podiatry follow-up is appropriate. As the wound heals, it will gradually contract and epithelialize from the edges inward. The fibrogranular base actually indicates healthy healing tissue.

Key Considerations for Wound Management

• Proper wound care including regular dressing changes
• Offloading pressure from the wound
• Monitoring for signs of infection Patients with diabetes or vascular disease may heal more slowly and require more vigilant monitoring. If the wound fails to progress with conservative management over several months, or if there are complications like persistent infection or poor granulation, surgical intervention might be reconsidered. However, most of these wounds heal successfully without additional surgery when properly managed with good wound care practices and appropriate treatment of underlying conditions like the osteomyelitis being addressed with antibiotics, as recommended for up to 6 weeks for diabetes-related foot osteomyelitis without bone resection or amputation 1.

From the Research

Wound Closure

• The provided studies do not directly address the question of whether wounds like the one described typically require closure weeks or months down the line 2, 3, 4, 5, 6.
• However, the studies suggest that the goal of wound treatment is to create an environment that promotes healing, which can be achieved through various methods, including moist wound dressings 2, negative pressure wound therapy 3, and hydrogel dressings 4.
• The treatment approach may involve a multidisciplinary strategy, including optimization of the wound environment, use of topical therapies, and wound dressings to facilitate healing 6.
• In some cases, wounds may be left to heal on their own through secondary intention, especially if they are surgically created or become infected 3.
• The decision to close a wound may depend on various factors, including the size and location of the wound, the presence of infection or other complications, and the overall health of the patient 5.

Wound Treatment

• The studies emphasize the importance of creating a moist environment to promote wound healing 2, 4.
• Negative pressure wound therapy may be used to enhance wound healing, but its effectiveness is unclear due to limited high-quality evidence 3.
• Hydrogel dressings are a type of modern wound dressing that can provide a favorable environment for wound healing, with advantages including positive degradation properties and targeted delivery of bioactive substances 4.
• Topical therapies and wound dressings can be used to optimize the wound environment and promote healing 6.

Patient Care

• Patients with chronic wounds, such as those with diabetes, may require ongoing care and management to promote healing and prevent complications 3, 6.
• Wound care professionals play a critical role in managing wounds and promoting healing, and may use a variety of treatments and therapies to achieve this goal 6.
• Patient education and instruction on wound care and management are also important aspects of care 5.