Orthopedics - Infected Lower Extremity Wound

Infected Lower Extremity Wound

Diagnosis/Definition

• An infected lower extremity wound is described as any slow or non-healing wound of the distal leg or foot showing signs or symptoms of infection.

Initial Diagnosis and Management

Lower extremity infected wounds not responding to standard outpatient therapy as anticipated and or complicated by one or more of the following conditions: 

• Signs and symptoms of infection (red; hot; swollen; painful area)
• Presence of deep space abscess (frank pus from wound; tense, swollen area; flocculence)
• Unresponsive to current antibiotic treatment
• Neuropathy
• History of foreign body
• Diabetes
• History of amputation (partial foot or partial lower extremity)
• History of osteomyelitis or exposed bone, ligament, joint structures
• History of neuromuscular disease processes’, autoimmune processes’ (rheumatoid arthritis, scleroderma) 
• Foot deformity
• End stage renal disease
• Compromised skin integrity
• Compromised nutritional status
• Deep vein thrombosis (DVT)
• Vascular compromise (thin shiny skin; edema; varicose veins, etc.)
• Disability affecting normal lower extremity movement or function
• History of Charcot foot (see CHARCOT FOOT REFERRAL GUIDELINE)

Ongoing Management and Objectives

• To decrease the rate of lower extremity infections.
• To decrease the rate of toe, foot and lower extremity amputation with prompt referral of active ulceration/ wounds with infection.
• To manage each patient’s condition with a combination of mechanical, medical and surgical therapies tailored specifically for the unique characteristics of the wound and infection being treated.

Indications for Specialty Care Referral

• All patients with infected slow or non-healing lower extremity wounds not responding to standard therapy and/or complicated by significant morbidity should be referred for evaluation to the Wound and Ostomy Clinic as an ASAP consult. The patient will require an approved consult to be seen.

Criteria for Return to Primary Care

• All patients should be followed by the primary care provider for treatment of all co-morbid conditions and routine care with the goal of optimal health and wellness for the whole patient.

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