Postoperative infection rates in foot and ankle surgery: a clinical audit of Australian podiatric surgeons, January to December 2007

Background.Surgical site infections are one of the most common post-operative complications encountered by foot and ankle surgeons. The incidence reported in the literature varies between 0.5 and 6.5%. The results of a 12-month Australia-wide clinical audit analysing the rates of postoperative infections in association with podiatric surgery are presented. Methods.De-identified patient data was collected from nine podiatric surgeons Australia-wide. Infections were identified according to Australian Council on Health Care Standards (ACHS) definitions and data was entered no earlier than thirty days post procedure. Results.A total of 1339 patient admissions and 2387 surgical procedures were reported using the International Classification of Diseases (ICD-10) and Medicare Benefit Schedule (MBS) coding systems. The overall infection rate was 3.1% and the rate of infection resulting in hospital re-admission was 0.25%. Conclusions.The benchmark results presented in this paper suggest that infection rates associated with podiatric surgery are well within accepted industry standards as stated in recent literature. What is known about the topic?The rates of infection in foot and ankle surgery have been reported in international literature to vary between 0.5 and 6.5%. No such data has been published to date, which describes the rate of infection following podiatric surgery in Australia. What does this paper add?This paper provides benchmark data on complication rates associated with Australian podiatric surgeons. Such data also informs health and hospital managers who may be considering podiatric surgery as an option for providing foot surgery services within the public hospital system. What are the implications for practitioners?This paper challenges podiatric surgeons to consider their own practice and whether it is a reflection of best practice.

Acute shortening: modular treatment modality for severe combined bone and soft tissue loss of the extremities

BACKGROUND

Acute shortening, using the Ilizarov technique followed by progressive lengthening, is one of the methods used to deal with complex fractures combined with severe soft tissue injuries.

METHODS

We have summarized 12 patients who underwent acute shortening and stabilization using the Ilizarov frame. Nine of them underwent progressive lengthening to restore the length. For three patients, angulation of the bone segments was performed to save them from excessive bone debridement.

RESULTS

Total wound closure and bone regeneration were achieved in all our patients. Five patients had pin-tract infection without involvement of the bone, and no major complications were noted.

CONCLUSION

Using this technique, we found some advantages. First, there is less need for free and local flaps. Second, there is a decrease in the operating time and donor-site morbidity (important for patients with multiple organ trauma). Third, it provides a good option for restoring defects in severe cases with combined bone and soft tissue defects in the same session. Fourth, its implementation for short bone defects (< 3 cm) gives acceptable aesthetic and functional results. Fifth, angulation of the segments and subsequent graduated correction of misalignment reduces the length of shortening needed in patients with severe soft tissue loss by sparing the bone from unnecessary debridement. Sixth, it permits definitive treatment using an external fixator device, enabling the possibility of early functional loading. On the basis of our experience, we suggest adopting this method for functional limb salvage after extensive complex high-energy injuries.