Addressing Surgical Dehiscence in a Diabetic Smoker following Tarsometatarsal Fusion from a Neglected Lisfranc Injury: A Case Study Utilizing Acellular Skin Grafts

Introduction: Neglected Lisfranc injuries in diabetic patients with a history of smoking pose significant challenges in surgical management, often resulting in complications such as surgical dehiscence. Acellular skin grafts present a promising approach to address these complications and facilitate wound healing in such cases. This case study aims to evaluate the effectiveness of acellular skin grafts in managing surgical dehiscence following tarsometatarsal fusion in a diabetic smoker with a neglected Lisfranc injury. Methods: We present the case of a 69-year-old female with past medical history of diabetes and notable history of smoking. After sustaining a Lisfranc injury she was initially treated non-operatively and presented to the office with a neglected injury with associated deformity. She was counseled on smoking cessation and underwent tarsometatarsal arthrodesis. During the post-operative period she developed a surgical dehiscence with large soft tissue defect, exposed hardware and osteomyelitis. She was evaluated by vascular and underwent stenting to improve blood flow. Additionally, she underwent multiple debridement with hardware removal, long term antibiotics and application of acellular fish skin graft.   Results: Patient experienced remarkable success following the application of multiple acellular fish skin grafts in the setting of surgical dehiscence following tarsometatarsal arthrodesis in a diabetic smoker. Discussion: Acellular fish skin graft emerges as a viable option for addressing surgical dehiscence in diabetic patients who are smokers following surgical dehiscence.   References: