Foot measures in patients with pes cavus with and without charcot-marie-tooth disease: A pilot study.

INTRODUCTION: Pes cavus often signals the presence of Charcot-Marie-Tooth (CMT) in adult patients, although its prevalence in the general population makes it a finding of unclear significance. METHODS: We undertook a pilot double cohort study to investigate the feasibility of comparing preselected bedside and radiographic foot measures in pes cavus patients with and without CMT. RESULTS: A total of 16 CMT and 11 non-CMT patients were recruited. Although no findings consistently met statistical significance, recruitment was highly limiting. CONCLUSIONS: Formalized foot measurement comparisons of CMT and non-CMT pes cavus are feasible. Larger studies will be necessary to determine if there are differences in foot structure based on the presence of a hereditary neuropathy. Muscle Nerve 59:122-125, 2019.

[Preliminary application of antibiotic bone cement directly inducing skin regeneration technology in repairing of wound in lateral toe flap donor area].

Objective: To investigate the feasibility and effectiveness of antibiotic bone cement directly inducing skin regeneration technology in the repairing of wound in the lateral toe flap donor area. Methods: Between June 2020 and February 2023, antibiotic bone cement directly inducing skin regeneration technology was used to repair lateral toe flap donor area in 10 patients with a total of 11 wounds, including 7 males and 3 females. The patients' age ranged from 21 to 63 years, with an average of 40.6 years. There were 3 cases of the distal segment of the thumb, 2 cases of the distal segment of the index finger, 1 case of the middle segment of the index and middle fingers, 1 case of the distal segment of the middle finger, and 3 cases of the distal segment of the ring finger. The size of the skin defect of the hand ranged from 2.4 cm×1.8 cm to 4.3 cm×3.4 cm. The disease duration ranged from 1 to 15 days, with an average of 6.9 days. The flap donor sites were located at fibular side of the great toe in 5 sites, tibial side of the second toe in 5 sites, and tibial side of the third toe in 1 site. The skin flap donor site wounds could not be directly sutured, with 2 cases having exposed tendons, all of which were covered with antibiotic bone cement. Results: All patients were followed up 6 months to 2 years, with an average of 14.7 months. All the 11 flaps survived and had good appearance. The wound healing time was 40-72 days, with an average of 51.7 days. There was no hypertrophic scar in the donor site, which was similar to the color of the surrounding normal skin; the appearance of the foot was good, and wearing shoes and walking of the donor foot were not affected. Conclusion: It is a feasible method to repair the wound in the lateral foot flap donor area with the antibiotic bone cement directly inducing skin regeneration technology. The wound heals spontaneously, the operation is simple, and there is no second donor site injury.

De Marco Formula effectiveness as an adjunctive therapy to prevent infected ischemic diabetic foot amputation and reduce plasma fibrinogen.

BACKGROUND: De Marco Formula (DMF) is a new procaine chemical combination of Procaine HCl and polyvinylpyrrolidone. A prospective randomized controlled clinical trial demonstrated that infected ischemic diabetic foot treatment with DMF for 52 days as an adjuvant with conventional therapy reduced major amputations. OBJECTIVE: To evaluate the possible association of clinical effectiveness and plasma fibrinogen reduction with DMF therapy. METHODS: Adult patients, 24 male/23 female, suffering from infected ischemic diabetic foot ulcers were randomly assigned to receive conventional therapy alone (group A, N=24) or combined with DMF (receiving 0, 15 ml/kg day i.m.) for ten days and then twice a week until lesion healing or completion of 52 days (group B, N=23). Fibrinogen concentrations were determined before and after a ten-day treatment period. Treatment clinical responses were considered favorable if major amputations were not needed. Pre and post-treatment fibrinogen values were compared within each group and between groups. Differences were considered statistically significant for p<0, 05. RESULTS: Fifty percent of group A patients (12/24) and 21.7% of the Group B (5/23) showed unfavorable responses (a 56.6% reduction for group B). There were not statistical differences between pre and post-treatment fibrinogen within Group A (406.7±49.08 vs. 354.6±62.5, p=0,11). However, post-treatment values were significantly lower within Group B (298.9±15.24 vs. 487.1±49.08, p=0, 0016). Patients who showed favorable responses had statistically lower fibrinogen concentrations than those with unfavorable responses (280±5.1 vs. 310±7,1, p=0.002) within group B. CONCLUSION: DMF combined with conventional therapy for infected ischemic diabetic foot was associated with plasma fibrinogen decrease.

Ischemic Toe Ulceration Due to Foreign Body Embolus From Hydrophilic Polymer-Coated Intravascular Device.

Hydrophilic polymer coatings are now widely applied to catheters and other intravascular devices used in neurovascular, cardiovascular, and peripheral vascular procedures. Emboli consisting of these materials have been previously identified in biopsies and autopsies following pulmonary infarction, stroke, gangrene, or death. We report a case involving a nonhealing foot ulcer that appeared following cardiac catheterization, stenting, and automatic implanted cardiac defibrillator (AICD) implantation in a patient without other evidence of significant peripheral artery disease. An 85-year-old woman with chronic atrial fibrillation, aortic valve stenosis, and coronary artery disease underwent coronary stenting and AICD implantation for ventricular tachycardia and syncope. She developed a toe ulcer shortly thereafter, which did not respond to standard treatment. A histological examination following amputation of the toe found amorphous basophilic material in capillaries adjacent to the edge of the ulcer, which was similar to material associated with hydrophilic polymer coatings. Ischemia and infarcts following endovascular procedures should not be presumed to result from thrombus or vascular disease, even if intravascular devices appear intact or properly placed after the procedure. To help establish the incidence of ischemia caused by hydrophilic polymer device coatings, if excision of ischemic or infarcted tissue after endovascular procedures using coated devices becomes necessary, the tissue should be evaluated microscopically. Surgeons should also consider the tolerance of distal organs to infarct or ischemia when selecting coated intravascular devices.

Matrix synthesis and cell proliferation in repaired flexor tendons within e-PTFE reconstructed flexor tendon sheaths.

Expanded polytetrafluoroethylene (e-PTFE) may be used as a barrier to reduce formation of restrictive adhesions following tendon surgery within the flexor tendon sheath region. In order to assess its effects on the cellular activity of healing tendons, synthesis and contents of matrix components and synthesis of DNA were compared in divided and sutured flexor tendons that either had been covered with e-PTFE membranes or with sham-operated tendon sheaths in 30 rabbits. At intervals of up to 12 weeks segments of the tendon repair sites were harvested, placed in wells and labelled with 35S-sulphate, 3H-proline and 3H-thymidine during short-term culture in vitro. Adverse tissue reactions and tendon disruptions were not observed at harvest. At each time interval synthesis of matrix components and DNA and contents of protein and collagen in the repaired tendon segments were similar in the two groups. Measured over all intervals, synthesis of non-collagen protein and contents of protein and collagen were lower in the e-PTFE groups. These results show that reconstruction of flexor tendon sheaths with e-PTFE membranes may not significantly impair cell proliferation but to some extent may reduce protein synthesis of healing tendons.

A cohort study of systemic and local complications of toe prostheses.

We investigated the role of toe implants in systemic disease and evaluated local complications after foot surgery. Information was obtained from the medical records of Kaiser Permanente (northern California) patients who had undergone toe surgery between 1979 and 1988. Computerized hospitalization records were used to identify patients with toe implants (N=814) and matched controls with foot surgery not involving implants (N=837). Brain cancer and alopecia areata occurred more among implant patients, whereas dysphagia occurred more among nonimplant patients. A larger proportion of implant patients were diagnosed with pain and swelling, tendonitis, and osteomyelitis or periostitis. Nonimplant patients were more often diagnosed with derangement of foot or ankle and delayed postoperative healing. We did not find a general association between implants and connective tissue diseases.

Lesser toe salvage with external fixation and autogenous bone grafting: a case series.

Lesser toe salvage secondary to soft tissue ulceration and underlying osteomyelitis is a challenge, and amputation is frequently the primary procedure recommended. The author presents an observational case series involving retrospective review of prospectively collected data of 4 lesser toe salvage procedures with external fixation and delayed autogenous bone grafting for the treatment of osteomyelitis in 4 consecutive patients. Each patient underwent initial resection of involved soft tissue ulceration and underlying osseous components of the lesser toe with application of external fixation and polymethylmethacrylate antibiotic-loaded bone cement spacer. Once eradication of osteomyelitis was confirmed clinically, the patient underwent delayed insertion of autogenous bone graft harvested from the ipsilateral calcaneus or osteocutaneous flap transfer from the fibular border of the ipsilateral great toe. There were 2 men and 2 women with a mean age of 56.5 years. Three patients had diabetes mellitus, and 1 had previous history of open fracture. There were 2 right feet and 2 left feet involved and 2 second, 1 third, and 1 fourth toe salvage procedures performed with a mean follow-up of 12 months. The external fixation device was maintained until complete osseous integration was verified, which occurred at a mean of 7.5 weeks. All procedures were deemed successful with complete osseous incorporation of the proximal and distal graft-host bone interfaces and no recurrent soft tissue ulcerations, osteomyelitis, toe deformity, or fracture about the bone graft sites.

[Repair of nasal columella and tip defects by using great/second toe web flap].

OBJECTIVE: To study the methods and therapeutic effect of repairing deformity of nasal columella and tip by anastomosing its blood vessels with those of the great/second toe web flap. METHODS: The donor site was the great/second toe web flap. Sewing the great/second toe web flap and nasal columella and tip together by using 5-0 silk thread, anatomizing facial artery and facial vein for three centimeters long behind submaximal, protecting lower jaw branch of facial nerve, separating a subcutaneous layer tunnel between nasal columella and one of facial artery and facial vein behind submaximal. Dorsal artery of foot, saphenous vein in the flap were anastomosed with the facial artery and facial vein behind submaximal through the tunnel under the subcutaneous layer. RESULTS: All flaps survived, satisfactory therapeutic effect was obtained. Postoperative follow-up was 0.5-1 year. The reconstructed columella showed satisfactory contour, good texture and color, and good resistance to injury. CONCLUSIONS: Great/second toe web flap is a ideal skin flap for repairing deformity of nasal columella and tip.

Subungual exostosis: a review of 16 cases focusing on postoperative deformity of the nail.

We reviewed the clinical features of 16 patients who underwent surgery for subungual exostosis, focusing on postoperative deformity of the nail. In 7 patients, the lesion did not destroy the nail bed and was excised with a fish-mouth-type incision. In 9 patients, the lesion destroyed the nail bed and was excised with a direct approach. In 5 of the 9 patients, artificial skin was applied after excision of the tumor because the defect of the nail bed was large. Good postoperative appearance of the nail was obtained by a fish-mouth-type incision when the tumor did not destroy the nail bed, although 2 patients had local recurrence. Onycholysis occurred postoperatively when the tumor destroyed the nail bed and the defect of the nail bed was large after excision of the tumor. Secondary nail bed reconstruction may be indicated in such cases with postoperative deformity of the nail.

The use of digital implants for the correction of hammer toe deformity and their potential complications and management.

This manuscript deals with use of silicone implants as part of the correction for hammer toe deformity. A brief description of the historical correction of hammer toe is presented, with emphasis placed on the development and use of silicone prostheses. The surgical procedure is discussed and an overview of the authors' long-term results are included. Analysis of an informal survey taken of several practitioners known to utilize digital implants is also presented. This manuscript primarily focuses on potential complications that may accompany the procedure. Management and prevention of these complications is also discussed.

Implant failure with particulate silicone synovitis (detritic synovitis).

The authors present a case of particulate synovitis due to a silicone hemi-implant. Other names for this condition are silastic detritic synovitis and silastic foreign body synovitis. Small, free pieces of silastic cause inflammation of the synovial tissues. A literature review also is presented.

Epigard: a synthetic skin substitute with application to podiatric wound management.

The authors present a synthetic skin substitute, Epigard, which was developed in 1973 and has been used worldwide for temporary coverage of open wounds. Epigard is a two-layer, non-medicated wound dressing which approximates the function of human skin. The article discusses the proper indications and usage of Epigard, as well as post operative wound management and definitive wound closure decisions. A case presentation involving a serious diabetic wound infection is discussed. At Doctors Hospital, Epigard has become an important adjunctive therapy in wound management by improving wound healing time and decreasing patient hospital stay.

Hard palate mucosal grafts for defects of the nail bed.

The authors present 2 children in whom a hard palate mucosal graft was used for a defect of the nail bed after resecting subungual exostosis. After the tumor was resected with the overriding nail bed, hard palate mucosa without periosteum was grafted to the nail bed defect. In both patients the graft took completely, and within 2 weeks after the operation the patients were able to enjoy activities of daily life, including athletic movement, without any symptoms. Nail growth was uneventful and was complete in 4 or 5 months after the operation without any complications. The authors think that a hard palate mucosal graft is a valid choice for a defect of the nail bed, and the mucosa does not need to be harvested with periosteum. The grafting of hard palate mucosa without periosteum to a defect of the nail bed contributes to a shorter healing time, resulting in a reduction in the period of restriction of movement in activities of daily life, and this is a great advantage in children.

Flexible hinge toe implant arthroplasty for rheumatoid arthritis of the first metatarsophalangeal joint: long-term results.

We report the long-term clinical results and survival rate of the implant in flexible hinge toe implant arthroplasty of the first metatarsophalangeal joint, combined with a shortening oblique osteotomy of the metatarsal neck in the lateral toes, in patients with rheumatoid arthritis. Between 1983 and 1990, arthroplasty was performed on 97 feet in 66 patients. Twenty-seven patients died; follow-up information was available for 60 feet in the remaining 39 patients, who were followed for an average of 12 years. Twenty-nine patients (74%) were satisfied with the outcome after surgery, 7 were satisfied but had some pain or recurrent deformities, and 3 were unsatisfied. Radiologically, visible fracture was identified in nine implants. Four implants were removed because of infection (n = 2) or recurrent deformity (n = 2); no implant was removed because silicone synovitis developed. With revision as the endpoint, the implant survival rate was 93% at 10 years, and with radiographic implant fracture as the endpoint, the implant survival rate was 87% at 10 years. Shortening oblique osteotomy of the lateral toes appeared to decrease the rate of implant fracture and should be performed concomitantly with implantation when rheumatoid forefoot deformities are being reconstructed.