ORLANDO, Fla. – Recognition of soft tissue problems following amputation can allow for earlier intervention and therefore better patient outcomes, according to Christian Ertl, MD, FACS, FACCWS in a presentation here at the 2010 American Orthotic and Prosthetic Association’s (AOPA) National Assembly.
Ertl presented an overview of the most common soft tissue problems and ways to recognize when a surgical intervention might be necessary. Following hospital discharge, a number of factors can quickly lead to a return trip if intervention is not sought rapidly. Ertl encouraged practitioners to “work for the greater good of the patient” above all else when it comes to intervention decisions.
“I don’t want you guys to walk out of here thinking you have to be worried about antibiotics, “ Ertl said. “I want you to recognize based on old-fashioned intuition … about when you have to get on the phone and call the surgeon and say ‘You have to see this patient’ and be insistent about it.”
According to Ertl, the Centers for Disease Control and Prevention (CDC) has identified surgical-site infections as a major health hazard. Approximately 2% to 5% of the annual surgical patients have a surgical-site infection.
“When you think about it as one in 24 patients, that is a pretty significant number,” Ertl said adding that an additional 8 weeks of care for someone who is diagnosed with a surgical-site infection is approximately $5,155 and can add as many as 14 days to a hospital stay.
In addition to the economic effects, this also delays healing, fit and the patient’s function restoration.
Ertl acknowledges the following signs that someone might indicate a larger problem: redness; heat; swelling; loss of function; sensitivity; draining or discharge; or intuition based on knowledge and experience. Additionally, the following signs would require urgent consults: open ulcers that require refitting; drainage or discharge; painful red streaks; strong odor; and high-risk patients including those with neuropathy and smokers.
He added that patient history is the best way to find a problem and families and close friends of the patients are the best allies who might be able to indicate a problem that the patient is not sharing.
