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We reviewed 33 patients with 37 wounds treated between November of 1991 and December of 1995 in the Wound Care Center. A two-stage debridement and closure technique for neuropathic foot ulcers was performed. Patients selected included those with obvious osteomyelitis and those who had failed nonsurgical treatment. The approach included initial surgical excision of the ulcer with biopsy, bone resection with biopsy, and deep culture. The second-stage procedure 4 to 8 days later included debridement of the wound and delayed closure. Intravenous antibiotic treatment using a central line was given postoperatively in patients with documented osteomyelitis for at least 6 weeks and in patients with infected soft tissues only for about 4 weeks. All patients remained nonweightbearing for 4 weeks; this was felt necessary to prevent separation of the wound edges. Four wounds in four patients failed to heal, and two of these went on to amputation. Satisfactory healing occurred in 29 of 33 patients and in 33 of 37 wounds. The authors conclude that two-stage surgical debridement and closure is an acceptable treatment in selected nonhealing diabetic (neuropathic) foot ulcers.

Rotationplasty was used in two cases of failed limb salvage in adults after tumor resection and reconstruction. Each patient had distal femoral osteosarcoma, one treated with osteoarticular allograft reconstruction, the other with a custom endoprosthetic reconstruction. Both patients had failure attributable to infection, and after multiple surgeries, elected to have rotationplasty. Both had complications associated with the rotationplasty but went on to have functional limbs with Musculoskeletal Tumor Society functional scores of 67% and 87%. One patient died of metastatic disease 29 months after rotationplasty, the other had no problems 50 months after rotationplasty. Although rotationplasty offers a functional improvement over transfemoral amputation in the salvage of failed tumor reconstructions, only 10 such cases have been reported in adults. Rotationplasty should be considered in selected patients for whom an amputation is being considered after failed limb salvage surgery.

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