Warren Joseph, DPM

Negative Pressure wound therapy (NPWT) using the KCI Vacuum Assisted Closure (VAC) device is a well recognized modality to assist in the healing of complex wounds. The case presented in this article demonstrates its use in a complicated patient with osteomyelitis of the 2nd MTP joint who refused definitive cure by partial ray amputation.

The patient was a 51 y/o female, 231 lbs with insulin dependent diabetes mellitus and a long history of smoking and non-adherence with medical advice. She was admitted with the diagnosis of septic arthritis of the 2nd MTP joint with contiguous osteomyelitis of the base of the proximal phalanx of the 2nd toe and the head of the 2nd metatarsal. She had cellulitis of the forefoot with an open draining ulceration in the 1st interspace that probed to the joint.

On the day of admission she was taken to the operating room and an incision and drainage was performed. The patient unequivocally refused partial ray amputation stating