Abstract
Foot infections associated with soft tissue emphysema, or the radiographic appearance
of gas, are widely considered to necessitate urgent decompression with excisional
debridement of the necrotic and infectious tissue burden. The objective of this investigation
was to describe anatomic features and clinical outcomes associated with the presence
of soft tissue emphysema in foot infections. A retrospective chart review was performed
of 62 subjects meeting selection criteria. These were primarily male (74.2%), with
a history of diabetes mellitus (85.5%), and without a history of previous lower extremity
revascularization (98.4%). The primary radiographic location of the soft tissue emphysema
was most frequently in the forefoot (61.3%), followed by the midfoot (21.0%), and
rearfoot (16.1%). The soft tissue emphysema was most frequently observed primarily
in the dorsal foot tissue (49.2%), followed by both dorsal and plantar foot tissue
(27.4%), and the plantar foot tissue (24.2%). The soft tissue emphysema was confined
to the primary anatomic location in 74.2% of subjects, while 25.8% of cases demonstrated
extension into a more proximal anatomic area. Eighty-two percent of subjects underwent
a bedside incision and drainage procedure on presentation in the emergency department,
and 95.2% underwent a formal incision and drainage procedure in the operating room
at 1.05 ± 0.79 (0-5) postadmission days. Twenty-seven percent of subjects had an unplanned
30-day readmission and 17.7% underwent an unplanned reoperation within 30 days following
the index discharge. Fifty-two percent of subjects underwent a minor or major amputation
during the index admission, while 33.9% eventually resulted in major limb amputation
within 12 months. We hope that this investigation adds to the body of knowledge and
provides expectations with respect to the evaluation and treatment of foot soft tissue
infections complicated by the presence of radiographic soft tissue emphysema.
Level of Clinical Evidence
Keywords
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Article info
Publication history
Published online: September 08, 2021
Footnotes
Financial Disclosure: None reported.
Conflict of Interest: Meyr serves on the ACFAS Board of Directors and as a JFAS section editor.
Identification
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© 2021 by the American College of Foot and Ankle Surgeons. All rights reserved.
