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This is a healthy teenager who underwent podiatric surgery for a tarsal coalition 6 months ago. Sutures were removed a month later and two weeks after that, a small opening along the surgical incision began to drain copious amounts of “egg yolk” colored fluid. She underwent a surgical revision and closure but a puffy area continued to develop along the scar and her Mom says that when the area above the scar is pressed, there is a “toot” of air and fluid. She’s now had this problem for half a year. When she was only 6 years old, she developed an abscess on this leg after an insect bite that required plastic surgery. Mom admits that her daughter’s right foot swells occasionally. The Mom does not have edema of her feet, but says that the patient’s father has problems with foot swelling. On examination this young patient has a positive Stemmer’s sign on this foot (the inability to pinch a fold of skin at the base of the second toe) and lymphatic fluid can be expressed from the tiny wound.

It’s a shame that the surgeon did not notice the patients’ puffy foot and toes before he performed an elective surgery. She has primary lymphedema and now has a non-healing wound that drains lymphatic fluid. It’s usually possible to get these wounds closed with compression bandaging, particularly in a young person.

Wounds are a SYMPTOM. Our job is to figure out what they are a symptom OF.

Here’s a positive Stemmer’s sign on the right foot where she had the wound.
This is a “negative” Stemmer’s sign. I examined the patient’s mother’s feet, and they are normal. You should be able to pinch a fold of skin at the base of the second toe like this. (Mom says that the patient’s father has foot swelling).

Dr. Fife sees patients at the CHI St. Luke's Hospital Wound Clinic in The Woodlands, Texas. For an appointment call (936) 266-2150.



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