Complicated post-amputation stump wound managed with a Limberg flap and persistent wound care: a case report

Osteomyelitis is a bone infection most commonly caused by bacteria. Treatment includes antibiotics, surgical removal of infected bone, or a combination of both. Because osteomyelitis frequently occurs in patients with diabetes and multiple comorbidities, perioperative and postoperative care are comprehensive and critical. Wound care after amputation remains challenging because of pre-existing infection, poor extremity vascularity, and the need for long-term patient compliance.

A 65-year-old man with prediabetes who lived in poor sanitary conditions presented with a chief complaint of left great toe pain and swelling. Pus formation and skin necrosis were noted, clearly indicating infection. Radiography demonstrated degeneration of the distal and proximal phalanges of the first toe, raising suspicion for osteomyelitis. A postoperative wound complication developed after toe amputation, requiring rhomboid-shaped debridement, excision of necrotic tissue, Limberg flap reconstruction, and multiple subsequent debridement procedures to achieve wound healing.

Wound management is important after all surgical procedures, particularly after amputation, which damages cutaneous, neural, musculoskeletal, and vascular structures and alters lymphatic drainage. This case emphasizes the importance of flap reconstruction as a protective wound barrier when joint disruption is suspected, while also highlighting the necessity of persistent wound dressing and repeated debridement. Patient compliance, the relationship between the patient and healthcare providers, and financial factors also play significant roles in the management of complicated wounds. This case report was prepared in accordance with the SCARE criteria.