J Wound Manag Res.  2020 Feb;16(1):37-42. 10.22467/jwmr.2019.00941.

Alternative Treatment for Infectious Arthritis in a Complicated Diabetes Mellitus Patient with Ankle Joint Instability

• Lee Y
• Lee M

• KMID: 2504084
• DOI: http://doi.org/10.22467/jwmr.2019.00941

Abstract

Treatment of diabetic foot infections requires attention to both local and systemic issues, as diabetes mellitus is accompanied by a high incidence of complications that delay wound healing and restrict treatment options. We present a patient with diabetes who had infectious arthritis of the ankle joint with a soft tissue defect involving the joint capsule. The comorbidities of the patient limited the options for treatment in reconstruction of the ankle joint defect. Therefore, nonabsorbable sutures bridging the periosteum of the fibula and calcaneus bones were applied to mimic the calcaneofibular ligament and secure the joint capsule. In addition, negative pressure wound therapy (NPWT) was administered to protect the joint space, absorb extra fluid, and promote wound healing. Acellular dermal matrix was used in combination with NPWT to enhance wound healing and tissue regeneration. Although methicillin-resistant Staphylococcus aureus was cultured from the wound several times, there were no signs that this treatment aggravated the infection. After 7 months of inpatient treatment, stable soft tissue coverage and ankle joint stabilization were achieved, allowing fair standing balance, gait and plantar flexion.

Keyword

Diabetic foot; Arthritis, infectious; Joint instability