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https://www.readbyqxmd.com/read/27865319/circular-external-fixation-as-a-primary-or-adjunctive-therapy-for-the-podoplastic-approach-of-the-diabetic-charcot-foot
#1
REVIEW
Daniel J Short, Thomas Zgonis
Numerous techniques have been described for surgical management of the diabetic Charcot foot. External fixation has become a main surgical tool for the reconstructive foot and ankle surgeon when dealing with the ulcerated diabetic Charcot foot. In the presence of an open wound and/or osteomyelitis, staged reconstruction with circular external fixation becomes ideal for salvage of the diabetic lower extremity. Also, circular external fixation can provide simultaneous compression and stabilization, correct the underlying osseous or soft tissue deformities, and surgically offload the diabetic Charcot foot...
January 2017: Clinics in Podiatric Medicine and Surgery
https://www.readbyqxmd.com/read/27865317/revisional-surgery-of-the-diabetic-charcot-foot-and-ankle
#2
REVIEW
Patrick R Burns, Spencer J Monaco
Charcot neuroarthropathy (CN) is a difficult problem for the foot and ankle surgeon. If surgery is required, little is known or available regarding the best methods and timing. When the initial attempt of reconstruction fails, revision of CN is even more demanding. One must take in to account all aspects, including nutrition, vascular status, infection control, short- and long-term blood glucose management, as well as other factors requiring laboratory monitoring and consult services. Once optimized, the biomechanics of the deformity can be addressed and decisions can be made on fixation devices...
January 2017: Clinics in Podiatric Medicine and Surgery
https://www.readbyqxmd.com/read/27865316/soft-tissue-reconstruction-pyramid-for-the-diabetic-charcot-foot
#3
REVIEW
Claire M Capobianco, Thomas Zgonis
Foot and ankle ulcerations in patients with diabetic Charcot neuroarthropathy (DCN) occur frequently and can be challenging to address surgically when conservative care fails. Patients with acute or chronic diabetic foot ulcers (DFU) are at continued risk for development of osteomyelitis, septic arthritis, gas gangrene, and potential lower extremity amputation. Concurrent vasculopathy and peripheral neuropathy as well as uncontrolled medical comorbidities complicate the treatment approach. In addition, pathomechanical forces left untreated may contribute to DFU recurrence in this patient population...
January 2017: Clinics in Podiatric Medicine and Surgery
https://www.readbyqxmd.com/read/27865314/surgical-treatment-options-for-the-diabetic-charcot-midfoot-deformity
#4
REVIEW
Yousef Alrashidi, Thomas Hügle, Martin Wiewiorski, Mario Herrera-Perez, Victor Valderrabano
Management of diabetic Charcot midfoot deformity is one of the most demanding aspects of foot and ankle surgery. Its treatment should aim at reducing the rate of complications, including foot and ankle amputations or limb loss. Attempting reconstruction at Eichenholtz stages I and II carries the risk of infection and loss of fixation. It is advisable to limit surgical reconstruction to Eichenholtz stage III in the absence of any evidence of infection or vascular insufficiency. Achilles lengthening or gastrocnemius-soleus release is an essential initial step in surgery...
January 2017: Clinics in Podiatric Medicine and Surgery
https://www.readbyqxmd.com/read/27694302/combination-of-open-subtotal-calcanectomy-and-stabilization-with-external-fixation-as-limb-salvage-procedure-in-hindfoot-infected-diabetic-foot-ulcers
#5
Luca Dalla Paola, Anna Carone, Giulio Boscarino, Giuseppe Scavone, Lucian Vasilache
Diabetic hindfoot ulcers, complicated by osteomyelitis, are associated with a high risk of major amputation. Partial calcanectomy, preceded by an effective management of the infection and of the eventual peripheral artery disease, can be considered as valid therapeutic option. We have evaluated a therapeutic protocol for diabetic hindfoot ulcers complicated by osteomyelitis, which, besides an adequate surgical debridement, considers a reconstructive pathway assisted by the positioning of a circular external fixator...
September 29, 2016: International Journal of Lower Extremity Wounds
https://www.readbyqxmd.com/read/27681806/treatment-of-large-complex-non-healing-wounds-with-cryopreserved-amniotic-suspension-allograft-a-case-series
#6
B Marcus
OBJECTIVE: Cryopreserved amniotic suspension allograft (CASA) is a regenerative tissue suspension containing amniotic membrane and amniotic fluid components used for soft-tissue repair, replacement, and reconstruction. The aim of this case series is to examine its effects in different wound types. METHOD: In a retrospective series CASA was applied to chronic non-healing wounds. All patients were treated at a single center between June 2013 and December 2014. The criterion for application of CASA was lack of progress toward wound healing despite standard treatments and adjuvant therapies...
October 2016: Journal of Wound Care
https://www.readbyqxmd.com/read/27673541/a-new-approach-for-reconstruction-of-diabetic-foot-wounds-using-the-angiosome-and-supermicrosurgery-concept
#7
Hyun Suk Suh, Tae Suk Oh, Ho Seung Lee, Seung Hwan Lee, Yong Pil Cho, Joong Ryul Park, Joon Pio Hong
BACKGROUND: Major vessels in the diabetic foot are often calcified and inadequate for use as recipient vessels. Thus, a supermicrosurgery technique using small branches or perforators from other collateral vessels with an adequate pulse may be an alternative method. This study evaluated outcome using the supermicrosurgery concept and the risk factors involved. METHODS: Ninety-five cases of diabetic foot reconstruction were reviewed; the average patient age was 57 years; average follow-up was 43...
October 2016: Plastic and Reconstructive Surgery
https://www.readbyqxmd.com/read/27556759/what-role-does-function-play-in-deciding-on-limb-salvage-versus-amputation-in-patients-with-diabetes
#8
Dane K Wukich, Katherine M Raspovic
BACKGROUND: Patients with diabetic foot disease are at an increased risk for lower extremity amputation (LEA), premature mortality, and reduced health-related quality of life. In the setting of chronic infection, significant tissue loss, and/or an unstable deformity, limb salvage may not be possible, and major amputation is necessary. METHODS: The primary goal of this study was to review the literature with an emphasis on the functional aspects associated with successful limb salvage versus major LEA...
September 2016: Plastic and Reconstructive Surgery
https://www.readbyqxmd.com/read/27524708/neuropathic-minimally-invasive-surgeries-nemesis-percutaneous-diabetic-foot-surgery-and-reconstruction
#9
REVIEW
Roslyn J Miller
Patients with peripheral neuropathy associated with ulceration are the nemesis of the orthopedic foot and ankle surgeon. Diabetic foot syndrome is the leading cause of peripheral neuropathy, and its prevalence continues to increase at an alarming rate. Poor wound healing, nonunion, infection, and risk of amputation contribute to the understandable caution toward this patient group. Significant metalwork is required to hold these technically challenging deformities. Neuropathic Minimally Invasive Surgeries is an addition to the toolbox of management of the diabetic foot...
September 2016: Foot and Ankle Clinics
https://www.readbyqxmd.com/read/27336348/-lower-limb-critical-ischaemia-in-patients-of-a-pyoseptic-surgery-unit
#10
A V Maksimov, K A Koreiba, R M Nuretdinov, R R Sadykov, S M Khizriev
The authors retrospectively analysed therapeutic results of treatment in a total of 749 patients of the Pyoseptic Surgery Unit with signs of lower limb critical ischaemia. Of these, 101 (13.5%) patients were found to have a pronounced septic process (successfully arrested in 88 patients). A further 86 (11.5%) patients were diagnosed with extended trophic alterations making revascularization unpromising. The incidence rate of "major" amputations in this group amounted to 34.2%, with a lethality rate of 5.9%...
2016: Angiologii︠a︡ i Sosudistai︠a︡ Khirurgii︠a︡, Angiology and Vascular Surgery
https://www.readbyqxmd.com/read/27036309/society-for-vascular-surgery-limb-stage-and-patient-risk-correlate-with-outcomes-in-an-amputation-prevention-program
#11
Marlin W Causey, Ayman Ahmed, Bian Wu, Warren J Gasper, Alex Reyzelman, Shant M Vartanian, Jade S Hiramoto, Michael S Conte
OBJECTIVE: Clinical decision making and accurate outcomes comparisons in advanced limb ischemia require improved staging systems. The Society for Vascular Surgery Lower Extremity Threatened Limb Classification System (Wound extent, Ischemia, and foot Infection [WIfI]) was designed to stratify limb outcomes based on three major factors-wound extent, ischemia, and foot infection. The Project or Ex-Vivo vein graft Engineering via Transfection III (PREVENT) III (PIII) risk score was developed to stratify patients by expected amputation-free survival (AFS) after surgical revascularization...
June 2016: Journal of Vascular Surgery
https://www.readbyqxmd.com/read/27015337/combination-of-vascular-intervention-surgery-and-free-tissue-transfer-for-critical-diabetic-limb-salvage
#12
Chieh Chou, Pao-Jen Kuo, Yen-Chou Chen, Shu-Hung Huang, Chih-Hau Chang, Yi-Chia Wu, Su-Shin Lee, Cheng-Sheng Lai, Sin-Daw Lin, Kao-Ping Chang, Yur-Ren Kuo
BACKGROUND: Complex, nontraumatic diabetic foot ulcers with peripheral vascular compromise often lead to extensive lower-limb amputation. The aim of this study is to determine the outcome of combined vascular intervention and free tissue transfer for critical diabetic limb salvage. MATERIALS AND METHODS: A total of 26 consecutive diabetic patients with 28 legs with diabetic foot ulcers who underwent limb salvage with a combination of revascularization (bypass surgery or endovascular angioplasty) and free flap transfers were reviewed...
February 2016: Annals of Plastic Surgery
https://www.readbyqxmd.com/read/26910652/microsurgical-reconstruction-of-plantar-ulcers-of-the-insensate-foot
#13
Dinesh Kadam
Background Plantar, neuropathic, or trophic ulcers are often found in patients with decreased sensation in the foot. These ulcers can be complicated by infection, deformity, and increased patient morbidity. Excision results in wider defects and local tissues are often insufficient for reconstruction Methods Total 26 free flaps were used in 25 patients to reconstruct plantar ulcers between years 2007 and 2013. The etiology included diabetic neuropathy (n = 13), leprosy (n = 3), spinal/peripheral nerve injury (n = 7), spina bifida (n = 1), and peripheral neuropathy (n = 1)...
June 2016: Journal of Reconstructive Microsurgery
https://www.readbyqxmd.com/read/26866804/skin-grafting-and-tissue-replacement-for-treating-foot-ulcers-in-people-with-diabetes
#14
REVIEW
Trientje B Santema, Paul P C Poyck, Dirk T Ubbink
BACKGROUND: Foot ulceration is a major problem in people with diabetes and is the leading cause of hospitalisation and limb amputations. Skin grafts and tissue replacements can be used to reconstruct skin defects for people with diabetic foot ulcers in addition to providing them with standard care. Skin substitutes can consist of bioengineered or artificial skin, autografts (taken from the patient), allografts (taken from another person) or xenografts (taken from animals). OBJECTIVES: To determine the benefits and harms of skin grafting and tissue replacement for treating foot ulcers in people with diabetes...
2016: Cochrane Database of Systematic Reviews
https://www.readbyqxmd.com/read/26813619/surgical-treatment-of-the-charcot-foot
#15
REVIEW
Michael S Pinzur
With the increased number of diabetics worldwide and the increased incidence of morbid obesity in more prosperous cultures, there has become an increased awareness of Charcot arthropathy of the foot and ankle. Outcome studies would suggest that patients with deformity associated with Charcot Foot arthropathy have impaired health related quality of life. This awareness has led reconstructive-minded foot and ankle surgeons to develop surgical strategies to treat these acquired deformities. This article outlines the current clinical approach to this disabling medical condition...
January 2016: Diabetes/metabolism Research and Reviews
https://www.readbyqxmd.com/read/26813618/innovations-in-diabetic-foot-reconstruction-using-supermicrosurgery
#16
Hyun Suk Suh, Tae Suk Oh, Joon Pio Hong
The treatment of diabetic foot ulceration is complex with multiple factors involved, and it may often lead to limb amputation. Hence, a multidisciplinary approach is warranted to cover the spectrum of treatment for diabetic foot, but in complex wounds, surgical treatment is inevitable. Surgery may involve the decision to preserve the limb by reconstruction or to amputate it. Reconstruction involves preserving the limb with secure coverage. Local flaps usually are able to provide sufficient coverage for small or moderate sized wound, but for larger wounds, soft tissue coverage involves flaps that are distantly located from the wound...
January 2016: Diabetes/metabolism Research and Reviews
https://www.readbyqxmd.com/read/26654740/reconstructive-vascular-surgery-and-the-extent-of-tissue-damage-due-to-diabetic-foot-ulcers-relates-to-risk-of-new-ulceration-in-patients-with-pad
#17
T Elgzyri, J Larsson, P Nyberg, J Thörne, K-F Eriksson, J Apelqvist
OBJECTIVE: There is limited information regarding new ulceration following the healing of ischaemic foot ulcers in diabetic patients. Our aim is to study new ulcerations in the same foot as the previous ulcer(s) in patients with diabetes and severe peripheral artery disease (PAD). METHOD: Patients with diabetes and severe PAD who healed from previous ulcer(s) (Wagner grade 1-5, at or below the ankle), were recruited for the prospective study from the time of healing of their ulcer...
December 2015: Journal of Wound Care
https://www.readbyqxmd.com/read/26612346/toe-resurfacing-with-a-thin-thoracodorsal-artery-perforator-flap
#18
Youn Hwan Kim, Ki Ho Kim, Kun-Yong Sung, Jeong Tae Kim, Sang Wha Kim
BACKGROUND: In toe reconstruction, amputation procedures are much more common than salvage procedures. However, toe resurfacing, rather than amputation, provides superior functional and aesthetic results. In this study, we report the clinical outcomes of toe resurfacing using a thin thoracodorsal artery perforator flap. PATIENTS AND METHODS: Between January 2004 and June 2013, a total of 15 patients underwent toe resurfacing using thoracodorsal artery perforator flaps...
November 27, 2015: Microsurgery
https://www.readbyqxmd.com/read/26564730/intramedullary-fixation-in-severe-charcot-osteo-neuroarthropathy-with-foot-deformity-results-in-adequate-correction-without-loss-of-correction-results-from-a-multi-centre-study
#19
MULTICENTER STUDY
Martinus Richter, Thomas Mittlmeier, Stefan Rammelt, Per-Henrik Agren, Sarah Hahn, Anica Eschler
BACKGROUND: Charcot osteo-neuroarthropathy (CN) of the foot can induce severe instability and deformity. Results of a consecutive clinical multi-centre study with Midfoot Fusion Bolt (MFB, Synthes GmbH, Oberdorf, Switzerland) are reported. METHODS: All patients (aged 18 years and older) treated between 2009 and 2013 with surgical reconstruction of the midfoot with MFB for CN were included. Demographics, pre-surgical health status, details of foot pathology, details of surgery, postoperative treatment, treatment failure, and adverse events were registered...
December 2015: Foot and Ankle Surgery: Official Journal of the European Society of Foot and Ankle Surgeons
https://www.readbyqxmd.com/read/26491507/head-loss-as-an-explanation-of-the-steal-phenomenon-in-microvascular-surgery
#20
Phillip E Ross, Frederic W-B Deleyiannis
Vascular steal has been cited to help explain end-organ ischemia after microvascular reconstruction. Attempts to clarify a mechanism of vascular steal have been made by modeling blood circulation after a simple electrical circuit, suggesting that the free flap provides a path of least resistance for blood flow and thereby compromises end-organ perfusion. We present a case of a posterior medial thigh perforator flap for the reconstruction of a diabetic foot ulcer in a patient with a single vessel providing inflow to the foot...
2015: Eplasty
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