Today what we’re going to do is we’re going to have a look at and talk about some infections.
Usually, infections will be secondary to a break in the skin. They can also be inter-digitally or between the toes. But for a case example, what we’re going to use today is an infection secondary to a post-op procedure, which doesn’t happen that often but it can happen. So we take the dressing off. What the patient may have reported or started to notice is that the toe has been feeling okay postoperatively, but there’s been an increase in the level of pain over the last couple of days.
They may have noticed that the area of wetness around the dressing has become larger, or there has started to be some increased swelling, or there is some malodour associated with the toe at the time of the dressing changes. Okay, those are all sorts of things to look for and would raise concern, if you did start to notice those things. So we take the dressing away.
Sometimes a good thing to do is to, if you do suspect that there is an infection is to chart your progress, or the progress of the wound by taking some photos of it and recording those and taking taking them in and showing the clinician. What is quite normal to have is a little bit of redness around in through the base here immediately after the surgery for sort of 48 hours. That is what we call a bit of a phenol flare. Phenol is the chemical that we use to cauterize the matrix back in through here and stop that section from growing back.
However, if the redness starts to extend further up the toe, or in the worst case scenario is you actually start to get tracking, that’s a real area of concern, and you need to do something about that straightaway. Doesn’t very often happen at all, but if you start to get tracking, then you need to go to the emergency department. A little bit of redness is reasonably normal and we’ve already talked about the increase in the amount of puss or exudate that comes from the wound. With these sorts of procedures postoperatively, you will get quite a bit of straw based exudate or fluid that leaks out of the wound and that will do that for several days afterwards and that’s quite normal. Because what we’ve done is we’ve cauterized and we’ve created a little burn down the end here on the base of the toe. So don’t be too concerned about that. It’s if it starts to become quite purulent quite thick, sort of more thickened, yellowy greeny sort of colour, there’s a little bit of malodour, increased pain, swelling and redness, then those are areas of concern and you need to get in touch with us ASAP.
Alternatively, pop in and see the doctor. Preferably go back and see the podiatrist who’s done the surgery though. Sometimes the infections will be caused by a little bit of tissue that may be sitting down in through the area, and that can be quite easily flipped out and cleaned up. The other things that you can do to help treat or manage the infections is that you can go back to doing salt baths if you’ve stopped and you can do those actually twice a day where you’d use a heaped teaspoon of salt and a warm bowl of water diluted. Make it nice and strong and soak your toe in those twice a day.
That’s quite an effective way of dampening down the infection. What the salt does is it’s a natural antiseptic and it also dilutes any infective material. Also with infections, what you would tend to do is you’d tend to use, go back to if you’ve stopped using, an antibacterial anti microbial type of cream like the Betadine or Crystaderm or one of those types of creams and you would dress it and change it daily.