Title : Can amputation be prevented in a case of madura foot
Abstract:
Mycetoma is a chronic, granulomatous infection, mainly involving the foot, is endemic to tropical and subtropical regions and is caused either by bacteria (actinomycetoma) or fungi (Eumycetoma). The disease typically involves cutaneous and subcutaneous planes, or sometimes bones, forming granulomatous nodules with multiple sinuses discharging coloured grains. Actinomycetomas are more responsive to antibiotics whereas eumycetomas are notoriously resistant, posing a therapeutic challenge. In view of this, the currently accepted treatment standard is debridement (local surgical excision) for small localised lesions, while in advanced cases amputation is deemed necessary. We present a case of eumycetoma foot since 15 years with extensive involvement of the foot including bones. Conventional wisdom would have suggested amputation but a limb salvage trial was given. The patient underwent thorough soft tissue debridement and local, antifungal impregnated beads insertion followed by oral antifungal for 3 months. During this period patient required soft tissue clearance two more times to eradicate fungal colonies which showed up later in the form of external sinuses. The final results were inspiring and have been presented in the paper, evoking a discussion and further exploration of whether amputation can be avoided in a case of eumycetoma foot.
