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Partial foot amputation

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https://www.readbyqxmd.com/read/28480286/the-association-between-geographic-density-of-infectious-disease-physicians-and-limb-preservation-in-patients-with-diabetic-foot-ulcers
#1
Meghan B Brennan, Glenn O Allen, Patrick D Ferguson, Joseph A McBride, Christopher J Crnich, Maureen A Smith
BACKGROUND: Avoiding major (above-ankle) amputation in patients with diabetic foot ulcers is best accomplished by multidisciplinary care teams with access to infectious disease specialists. However, access to infectious disease physicians is partially influenced by geography. We assessed the effect of living in a hospital referral region with a high geographic density of infectious disease physicians on major amputation for patients with diabetic foot ulcers. We studied geographic density, rather than infectious disease consultation, to capture both the direct and indirect (eg, informal consultation) effects of access to these providers on major amputation...
2017: Open Forum Infectious Diseases
https://www.readbyqxmd.com/read/28476397/cryoglobulinemia-a-rare-cause-of-digital-gangrene-after-elective-foot-surgery
#2
Catherine L Churchill, James R Polowczyk
The development of gangrene after elective digital surgery is a rare complication. We present a case of a patient with normal preoperative vascular examination findings and a history significant for untreated hepatitis C. The patient underwent revisional second toe arthrodesis and plantar plate repair with pin fixation. After surgery, she developed gangrene and ultimately required partial digital amputation. The wound at the amputation site worsened postoperatively, warranting a rheumatologic evaluation that revealed previously undiagnosed cryoglobulinemia...
May 2017: Journal of Foot and Ankle Surgery: Official Publication of the American College of Foot and Ankle Surgeons
https://www.readbyqxmd.com/read/28450144/while-mortality-rates-differ-following-dysvascular-partial-foot-and-transtibial-amputation-should-they-influence-the-choice-of-amputation-level
#3
Michael Dillon, Stefania Fatone, Matthew Quigley
While there is strong evidence to show that the risk of dying after transtibial amputation is higher than partial foot amputation, we are concerned by the implication that amputation level influences mortality, and that such interpretations of the evidence may be used to inform decisions about the choice of amputation level. We argue that the choice of partial foot or transtibial amputation does not influence the risk of mortality. The highest mortality rates are observed in studies with older people with more advanced systemic disease and multiple comorbidities...
April 24, 2017: Archives of Physical Medicine and Rehabilitation
https://www.readbyqxmd.com/read/28326157/partial-calcanectomy-and-ilizarov-external-fixation-may-reduce-amputation-need-in-severe-diabetic-calcaneal-ulcers
#4
Mehmet Orçun Akkurt, Ismail Demirkale, Ali Öznur
Objective: The treatment of diabetic hindfoot ulcers is a challenging problem. In addition to serial surgical debridements, hyperbaric oxygen therapy and local wound care play important roles in the surgeon's armamentarium, for both superficial infection and gangrene of the soft tissue, often complicated by osteomyelitis of the calcaneus. The purpose of this study was to evaluate the results of an aggressive approach from diagnosis to treatment of calcaneal osteomyelitis in foot-threatening diabetic calcaneal ulcers...
2017: Diabetic Foot & Ankle
https://www.readbyqxmd.com/read/28288686/outcomes-of-dysvascular-partial-foot-amputation-and-how-these-compare-to-transtibial-amputation-a-systematic-review-for-the-development-of-shared-decision-making-resources
#5
Michael P Dillon, Matthew Quigley, Stefania Fatone
BACKGROUND: Dysvascular partial foot amputation (PFA) is a common sequel to advanced peripheral vascular disease. Helping inform difficult discussions between patients and practitioners about the level of PFA, or the decision to have a transtibial amputation (TTA) as an alternative, requires an understanding of the current research evidence on a wide range of topics including wound healing, reamputation, quality of life, mobility, functional ability, participation, pain and psychosocial outcomes, and mortality...
March 14, 2017: Systematic Reviews
https://www.readbyqxmd.com/read/28288436/cell-therapy-of-critical-limb-ischemia-in-diabetic-patients-state-of-art
#6
REVIEW
Michal Dubský, Alexandra Jirkovská, Robert Bem, Andrea Nemcová, Vladimira Fejfarová, Edward B Jude
In this review we report on the state of cell therapy of critical limb ischemia (CLI) with respect to differences between diabetic and non-diabetic patients mainly from the clinical point of view. CLI is the most severe form of peripheral arterial disease and its diagnosis and treatment in diabetic patients is very difficult. The therapeutic effect of standard methods of CLI treatment is only partial - more than one third of diabetic patients are not eligible for standard revascularization; therefore, new therapeutic techniques such as cell therapy have been studied in clinical trials...
February 27, 2017: Diabetes Research and Clinical Practice
https://www.readbyqxmd.com/read/28089125/long-term-outcomes-of-permanent-cement-spacers-in-the-infected-foot
#7
Tammer Elmarsafi, Noah G Oliver, John S Steinberg, Karen K Evans, Christopher E Attinger, Paul J Kim
When osteomyelitis occurs in the infected foot, cement spacers have been used as a limb salvage tool. The aim of the present study was to assess the longevity and outcomes in high-risk, low-demand patients who have undergone resection of bone and subsequent placement of permanent antibiotic-eluting cement spacers in the foot. A retrospective review case series of 30 patients who had undergone placement of a permanent antibiotic-eluting cement spacer in the foot were evaluated for retention, spacer exchange, removal, amputation, and functional status...
March 2017: Journal of Foot and Ankle Surgery: Official Publication of the American College of Foot and Ankle Surgeons
https://www.readbyqxmd.com/read/27713614/using-rivaroxaban-as-thrombolytic-treatment-for-a-patient-of-pedal-arch-arterial-thrombosis-with-suboptimal-result-of-endovascular-therapy
#8
Hsin-Fu Lee, Yi-Hsin Chan, Chun-Li Wang
A 77-year-old male with subacute right foot ischemia was treated with endovascular therapy to relieve total thrombosis of the pedal arch extending from the dorsalis pedis of the anterior tibial artery into the posterior tibial artery, plantar segment. Because the procedure was only partially successful, rivaroxaban was used for thrombolytic treatment resulting in improvement of the patient's ischemic pain and avoidance of gangrenous progression and surgical amputation. This is the first report describing successful recanalization of pedal arch arterial thrombosis using rivaroxaban in a patient after suboptimal results of endovascular therapy...
September 2016: Acta Cardiologica Sinica
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
#9
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/27676893/articulated-vs-fixed-carbon-fiber-prosthesis-in-individual-with-partial-foot-amputation-study-case
#10
Marie Laberge-Malo, Reggie C Hamdy, Laurent Ballaz, Audrey Parent, Annie Pouliot
OBJECTIVE: Toe filler combined to ankle-foot orthosis (AFO) can be used to improve gait after a partial foot amputation. The AFO supports the plantar aspect of the foot, and the toe filler gives a longer lever arm that helps for pivoting over the lost metatarsals. However, the AFO type can influence gait parameters. The objective of this study case was to evaluate the effect of prosthesis with toe filler combined to: - an articulated AFO; - a fixed carbon-fiber AFO on gait. PATIENTS AND METHODS: A gait analysis was practiced on a 20-year-old male with a partial foot amputation...
September 2016: Annals of Physical and Rehabilitation Medicine
https://www.readbyqxmd.com/read/27673541/a-new-approach-for-reconstruction-of-diabetic-foot-wounds-using-the-angiosome-and-supermicrosurgery-concept
#11
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/27617406/burn-wound-mucormycosis-a-case-study-on-poor-wound-healing
#12
Bryan Stanistreet, Derek Bell
Mucormycosis is a rare, rapidly progressive and often fatal fungal infection. The rarity of the condition lends itself to unfamiliarity, delayed treatment, and poor outcomes. Diagnosis of fungal infections early enough to enable appropriate treatment occurs in less than half of affected patients. A 56-year-old male with a history of diabetes mellitus II, hepatitis C, and intravenous drug abuse was involved in a rollover motor vehicle accident. He sustained circumferential partial and full-thickness burns to his lower extremities with 20% BSA burns...
March 2017: Journal of Burn Care & Research: Official Publication of the American Burn Association
https://www.readbyqxmd.com/read/27594645/complete-fifth-ray-amputation-with-peroneal-tendon-transfer-to%C3%A2-the%C3%A2-cuboid-a-review-of-consecutive-cases-involving-lateral-column%C3%A2-neuropathic-foot-ulceration-and-osteomyelitis
#13
Troy J Boffeli, Steven R Smith, Kyle W Abben
Nonhealing wounds along the fifth metatarsal associated with neuropathy and bone deformity frequently become complicated with osteomyelitis. Our surgical technique for complete fifth ray amputation with peroneal tendon transfer has been previously published. The present study evaluated the outcomes regarding success with initial healing and intermediate-term limb survival after this procedure, which is intended to resolve infection, remove bone deformity, heal and prevent recurrence of lateral column wounds, and maintain functional stability of the foot...
November 2016: Journal of Foot and Ankle Surgery: Official Publication of the American College of Foot and Ankle Surgeons
https://www.readbyqxmd.com/read/27474704/a-rapid-decline-in-corneal-small-fibers-and-occurrence-of-foot-ulceration-and-charcot-foot
#14
Cirous Dehghani, Anthony W Russell, Bruce A Perkins, Rayaz A Malik, Nicola Pritchard, Katie Edwards, Ayda M Shahidi, Sangeetha Srinivasan, Nathan Efron
We present clinical, neuropathy and corneal nerve morphology data in a participant with type 2 diabetes who developed diabetic foot ulceration, partial amputation and Charcot during a longitudinal observational study. While conventional measures of neuropathy did not deteriorate significantly, corneal nerve parameters showed a rapid reduction prior to the development of foot complications.
November 2016: Journal of Diabetes and its Complications
https://www.readbyqxmd.com/read/27442683/ultrasound-guided-bilateral-combined-inguinal-femoral-and-subgluteal-sciatic-nerve-blocks-for-simultaneous-bilateral-below-knee-amputations-due-to-bilateral-diabetic-foot-gangrene-unresponsive-to-peripheral-arterial-angioplasty-and-bypass-surgery-in-a-coagulopathic
#15
Sung Hye Byun, Jonghoon Lee, Jong Hae Kim
BACKGROUND: Patients on antiplatelet therapy following percutaneous coronary intervention can become coagulopathic due to infection. Performing regional anesthesia for bilateral surgery in such cases is challenging. We report a case of successful combined inguinal femoral and subgluteal sciatic nerve blocks (CFSNBs) for simultaneous bilateral below-knee amputations in a coagulopathic patient on antiplatelet therapy. METHODS: A 70-year-old male patient presented with pain in both feet due to diabetic foot syndrome...
July 2016: Medicine (Baltimore)
https://www.readbyqxmd.com/read/27437920/the-diabetic-foot-in-a-multidisciplinary-team-setting-number-of-amputations-below-ankle-level-and-mortality
#16
T E Wilbek, R B Jansen, B Jørgensen, O L Svendsen
Aim: To describe the number of minor lower extremity amputations and mortality for diabetes patients treated by a specialized multidisciplinary foot care team. Methods: A retrospective descriptive study of medical records from patients with diabetes treated with minor amputations at the Copenhagen Wound Healing Center (CWHC) at Bispebjerg Hospital from 1996-2013. Results: 777 diabetes patients treated with minor amputations were included. 77% were males and 23% were females. 80% had T2 diabetes and 20% had T1 diabetes...
October 2016: Experimental and Clinical Endocrinology & Diabetes
https://www.readbyqxmd.com/read/27379857/-hallux-amputation
#17
S Ochman, M J Raschke, C Stukenborg-Colsman, K Daniilidis
OBJECTIVE: Debridement of infected tissue with the main aim being the re-establishment of mobilization with preservation of standing and walking ability. Prevention of secondary pressure points or amputations due to inadequate resection or deficient soft tissue cover. INDICATIONS: In the case of increasing necrosis of the big toe, surgical abrasion and/or amputation is considered unavoidable. Other indications where surgery could be considered include diabetes and its associated angiopathies together with peripheral arterial angiopathy...
October 2016: Operative Orthopädie und Traumatologie
https://www.readbyqxmd.com/read/27283728/stepwise-surgical-approach-to-diabetic-partial-foot-amputations-with-autogenous-split-thickness-skin-grafting
#18
Crystal L Ramanujam, Thomas Zgonis
In the surgical treatment of severe diabetic foot infections, substantial soft tissue loss often accompanies partial foot amputations. These sizeable soft tissue defects require extensive care with the goal of expedited closure to inhibit further infection and to provide resilient surfaces capable of withstanding long-term ambulation. Definitive wound closure management in the diabetic population is dependent on multiple factors and can have a major impact on the risk of future diabetic foot complications. In this article, the authors provide an overview of autogenous skin grafting, including anatomical considerations, clinical conditions, surgical approach, and adjunctive treatments, for diabetic partial foot amputations...
2016: Diabetic Foot & Ankle
https://www.readbyqxmd.com/read/27015337/combination-of-vascular-intervention-surgery-and-free-tissue-transfer-for-critical-diabetic-limb-salvage
#19
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/26922732/incidence-and-clinical-significance-of-heterotopic-ossification-after-partial-ray-resection
#20
Troy J Boffeli, Jonathan C Thompson, Brett J Waverly, Ryan R Pfannenstein, Kevin J Mahoney
Heterotopic bone growth is a common finding after partial foot amputation that can predispose to recurrent wounds, osteomyelitis, and reamputation. Heterotopic ossification is the formation of excessive mature lamellar bone in the soft tissues adjacent to bone that is exacerbated by trauma or surgical intervention. The relevance of heterotopic ossification is dependent on its anatomic location. Its occurrence as a sequela of partial foot amputation can lead to prominence on the plantar aspect of the foot that can predispose the patient to recurrent neuropathic ulceration or preclude appropriate wound healing...
July 2016: Journal of Foot and Ankle Surgery: Official Publication of the American College of Foot and Ankle Surgeons
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