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Group B and F Beta Streptococcus Necrotizing Infection–Surgical Challenges with a Deep Central Plantar Space Abscess

A Diabetic Limb Salvage Case Report

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  • 1 Departments of Surgery and Podiatric Surgery, Southern Arizona Veteran Affairs Health Care System, Tucson, Arizona.
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We present the case of a 66-year-old, type II diabetic male with a deep wound to the plantar-lateral aspect of his right hallux. On examination, the central plantar compartment of his right foot was moderately erythematous and tender on palpation. After obtaining a deep wound culture, treatment was complicated by a progression of a group B and F beta streptococcus, necrotizing infection. The patient underwent a right hallux amputation, followed by a plantar medial incision for drainage of an abscess to the medial and central plantar compartments of the foot. Due to the extent and limb threat of the infection, the patient ultimately underwent a transmetatarsal amputation. Advanced healing modalities were also employed to decrease wound healing times, which allowed the patient to achieve early weightbearing and return to activities of daily living. This study depicts how the astute podiatric surgeon needs to make a decision in a timely manner to surgically debride all nonviable and necrotic tissue in order to minimize further amputation and preserve foot function.

Corresponding author: Jason M. Mendivil, DPM, Departments of Surgery and Podiatric Surgery, Southern Arizona Veteran Affairs Health Care System, 3601 S 6th Avenue, Tucson, AZ 85723. (E-mail: jasonmendivildpm@yahoo.com)