Retained Surgical Cotton Ball Leading to Chronic Calf Wound

Retained surgical items, such as cotton balls (gossypibomas), are rare yet preventable complications that may cause chronic infection and diagnostic difficulty. We report the case of a 65-year-old man with a non-healing right calf wound and sinus tract persisting for 1 year following orthopedic surgery. Magnetic resonance imaging (MRI) revealed an abscess characterized by T1-weighted hypointensity and T2-weighted spiral-like low-signal fringes, prompting surgical exploration. A retained cotton ball was identified and excised, followed by debridement and local rotational flap closure. The patient achieved complete recovery without recurrence. A review of 26 published lower-limb cases indicates that most gossypibomas occur after fracture fixation, often presenting with long latency, nonspecific symptoms, and variable MRI appearances. Preventive strategies include rigorous counting, enhanced team communication, and emerging tracking technologies such as radio-frequency identification (RFID) and barcode systems. This case emphasizes early recognition of atypical chronic wounds and supports incorporating automated tracking into surgical workflows to prevent retained foreign bodies and improve patient safety.