A 30 year-old gentleman presented to me in clinic with the history of having dropped an iron bar on his toe 15 days prior to coming to clinic. He had first sought the treatment of the local healers. He unwrapped his foot to reveal a big toe that was no longer big. An ulcer encircled the toe joint and the end of the toe was shrunken to half the size of it’s counterpart on the other foot. It was nearly black (much darker than the man’s normal pigment), hard and extremely easy to move.
I told the man that I thought it needed to be amputated. The translation of his response was: “the patient will agree.” He came back the next morning for amputation.
One of the other volunteer doctors from Argentina / Spain, Dr. Tomas Rebora, helped me with the procedure. We gave the patient ketamine anesthesia. Because the wound appeared infected, I made the skin incisions just below where the good skin began. The goal of the amputation was to remove the toe bones (phalanges) down to the joint with the foot bone (metatarsal). (Because the toe bones connect to the foot bones…)
As I began the amputation, Tomas clamped the end of the toe to hold it out of the way, but with little force at all, he pulled it all the way off. Evidently, the patient had a broken toe which had been made worse by local treatment. The jagged edge of the remaining bone stuck out from the muscles and tendons. Tomas helped me muscle out the bone from the joint. I think at times I am too careful. After removing the bones, we made sure to stop any bleeding and sutured the wound. I did not have much of a skin flap to work with due to the infected skin circumscribing the toe. I closed the muscles layer and then the skin.
I started him on Cloxacillin (the antibiotic of choice here at BMC for skin infections) due to the high risk of infection for this wound, gave him a tetanus booster and instructed him to come back for daily cleaning and dressings. Hopefully, I will be able to see him in clinic before I leave to check on the progress of his healing.