Mechanical control

During the peri- and postoperative period, bed rest is essential with elevation of the limb to relieve oedema and afford heel protection. Prophylaxis of deep vein thrombosis should be carried out using a low molecular weight heparin subcutaneously daily. Low molecular weight

Fig. 6.28 (a) The wound has developed bluish discolouration, (b) The wound is breaking down, (c) The wound is sloughy and necrotic, (d) After 4 months the leg is fully healed and the bypass is still working.

Fig. 6.28 (a) The wound has developed bluish discolouration, (b) The wound is breaking down, (c) The wound is sloughy and necrotic, (d) After 4 months the leg is fully healed and the bypass is still working.

Fig. 6.29 (a) Severe sepsis with bluish discolouration of 3rd and 4th toes secondary to septic arteritis, (b) The patient underwent amputation of the 3rd and 4th rays, (c) A split-skin graft is applied to the tissue defect, (d) Foot has healed.

heparin is as effective and as safe as unfractionated heparin in the prevention of venous thromboembolism. The standard prophylactic regimen does not require monitoring.

In the neuropathic foot, non-weightbearing is advis able initially and then off-loading of the healing postoperative wound may be achieved by casting techniques.

After operative debridement in the neuroischaemic foot, especially when revascularization has not been possible, non-weightbearing is advised until the wound is healed.

If necrosis is to be treated conservatively, by autoamputation, which can take several months, then the patient needs a wide-fitting shoe such as a Dru shoe to accommodate foot and dressings, or a 'Scotchcast' boot.

Patients should walk as little as possible.

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