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September 1996

Management of Ulcers With Exposed Achilles Tendon Using Occlusive Dressings

Author Affiliations

St Louis University Health Sciences Center, St Louis, Mo

Arch Dermatol. 1996;132(9):1007-1008. doi:10.1001/archderm.1996.03890330017002

REPORT OF A CASE  A 60-year-old, generally healthy, white woman with borderline hypertension underwent hallux valgus repair, hammertoe correction, and bunionectomy of her left foot. The postoperative period was uneventful except for mild pneumonia, which was successfully treated with amoxicillin. Within 2 weeks of the procedure, an nonexudative shallow erosion, 1×1 cm in diameter, developed on the posterior aspect of the patient's foot, overlying the Achilles tendon proximal to its attachment to the calcaneus. Conservative therapy consisting of mechanical scrubbing and an elastic compression bandage did not heal the wound.Six weeks after the operation, the erosion had progressed to a full-thickness, painful ulcer exposing the Achilles tendon. Whirlpool therapy, oral antibiotics, and a variety of local regimens including topical antibiotics (eg, neomycin sulfate and silver sulfadiazine cream) were tried, without success. A workup to uncover the underlying reasons for the poor wound healing, including Doppler examination of the lower

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