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1.
J Pediatr Orthop ; 40(1): e30-e36, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-30950938

RESUMO

BACKGROUND: The phalanx bones in several cases of lateral polydactyly of foot revealed complicated alignment with radiographic findings revealing medial-protrusion and lateral deviation of the middle phalanx. We previously defined such cases as showing "mosaic-like alignment" and demonstrated favorable postoperative outcomes using our surgical procedure. The aim of this study was to evaluate the midterm and long-term postoperative outcomes in such cases. METHODS: The study included 17 feet from 16 patients; 5 male and 11 female, with one bilateral case. The radiographic findings in all cases revealed a mosaic-like alignment of phalanges. Average age of the patients at the initial surgery was 12 months and average duration of post-operative follow-up was 89 months (60 to 132 mo). The surgical procedures were focused on the alignment between the distal and proximal phalanges independent of the middle phalanx alignment. Ligamentous joint stability was restored using collateral ligament reconstruction. We retrospectively evaluated post-operative outcomes, and subjective evaluation by the patients and parents was carried out. RESULTS: No cases revealed either varus or valgus deformities, pigmentation of the grafted skin, or functional disturbance. As for postoperative complications, we observed visible thickening in 7 toes, 3 of which further underwent partial resection of the middle phalanx. Subjective evaluation of the postoperative results by the patients and parents was "very satisfied" or "satisfied" in 15 of 16 cases. CONCLUSION: On the basis of our midterm to long-term postoperative outcomes, we believe that our method of surgical reconstruction provides a new option for the treatment of lateral polydactyly of the foot with mosaic-like alignment of the phalanx bones. LEVEL OF EVIDENCE: Level IV-therapeutic studies.


Assuntos
Polidactilia/cirurgia , Dedos do Pé/anormalidades , Criança , Pré-Escolar , Ligamentos Colaterais/cirurgia , Feminino , Seguimentos , Humanos , Lactente , Masculino , Satisfação do Paciente , Complicações Pós-Operatórias/etiologia , Complicações Pós-Operatórias/cirurgia , Radiografia , Procedimentos Cirúrgicos Reconstrutivos/efeitos adversos , Reoperação , Estudos Retrospectivos , Fatores de Tempo , Falanges dos Dedos do Pé/anormalidades , Falanges dos Dedos do Pé/diagnóstico por imagem , Falanges dos Dedos do Pé/cirurgia , Dedos do Pé/cirurgia , Resultado do Tratamento
2.
J Am Podiatr Med Assoc ; 109(4): 322-326, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31762309

RESUMO

A schwannoma is a solitary benign tumor composed of Schwann cells occurring anywhere in the peripheral nervous system. The diagnosis of a schwannoma is often difficult to make by clinical presentation and advanced imaging modalities. We present a case report of a 61-year-old Hispanic woman with a left-foot, third-digit, soft-tissue mass. The diagnosis of a schwannoma of the proper digital nerve was made postsurgically by means of histopathologic and immunohistochemistry parameters. This is a rare location for a schwannoma, and neurogenic tumor should be included in the differential diagnosis of soft-tissue mass, as there have been prior case reports.


Assuntos
Doenças do Pé/patologia , Neurilemoma/patologia , Neoplasias do Sistema Nervoso Periférico/patologia , Dedos do Pé/inervação , Feminino , Doenças do Pé/diagnóstico por imagem , Doenças do Pé/cirurgia , Humanos , Pessoa de Meia-Idade , Neurilemoma/diagnóstico por imagem , Neurilemoma/cirurgia , Neoplasias do Sistema Nervoso Periférico/diagnóstico por imagem , Neoplasias do Sistema Nervoso Periférico/cirurgia , Dedos do Pé/diagnóstico por imagem , Dedos do Pé/cirurgia , Ultrassonografia
3.
Handchir Mikrochir Plast Chir ; 51(6): 434-439, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31698486

RESUMO

BACKGROUND: After loss of a thumb, the big toe is a possible donor site for reconstruction with wrap-around free flap and trimmed-toe transfer techniques. Early reconstructions seem to reduce the risk of post-operative infections, despite several studies that show different infection rates of the recipient site in immediate toe-to-hand transfer. The authors carried out a retrospective analysis of their experience in thumb reconstruction with big toe transfer and evaluated the results achieved with both immediate and delayed reconstructions in terms of infection occurrence. PATIENTS AND METHODS: From 2000 to 2017, patients who presented cut, crush and avulsion injuries in the thumb were selected and 33 toe-to-thumb transfers were performed. Patients were divided into two groups: in group A, patients underwent immediate reconstruction, while in group B delayed reconstructions were performed. The two groups received identical antimicrobial prophylaxis. Reliability of the immediate or delayed reconstruction was compared in terms of flap survival, requirement for a secondary intention healing and, in particular, rate of infection. RESULTS: 29 male and 4 female patients were treated. Toe-to-thumb transfers were performed in both groups: in group A, 8 wrap-around free flaps and 4 trimmed toe transfers; in group B, 11 wrap-around and 10 trimmed toe transfers. No flap loss occurred in either groups. No cases of infection were detected in the transferred toes. CONCLUSION: For toe-to-thumb transfer, there are published reports of a wide range of infection rates of the recipient sites. The authors compared their results in terms of infection rate between immediate reconstruction, group A, and delayed reconstruction, group B. Immediate toe-to-thumb transfer showed equal success rates to delayed transfer. No statistically significant difference in risk of infection between the two groups was found. Results showed that the immediate reconstruction was as safe and reliable as the delayed one.


Assuntos
Amputação Traumática , Procedimentos Cirúrgicos Reconstrutivos , Polegar/cirurgia , Dedos do Pé/transplante , Amputação Traumática/cirurgia , Feminino , Traumatismos dos Dedos/cirurgia , Deformidades Adquiridas da Mão/cirurgia , Humanos , Masculino , Reprodutibilidade dos Testes , Estudos Retrospectivos , Cirurgia Plástica/métodos , Dedos do Pé/cirurgia
4.
J Am Podiatr Med Assoc ; 109(5): 401-406, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31599675

RESUMO

Onychocryptosis is a common pathology treated by podiatry medical services, and in a considerable percentage, surgical procedures are required to achieve a solution. There are multiple surgical approaches for ingrown toenails, both incisional procedures and nonincisional procedures, such as chemical matrixectomies and physical matrixectomies using carbon dioxide laser. This study presents a surgical procedure for onychocryptosis using a physical matrixectomy with a 1064-nm laser applied by means of a 400-µm optical fiber and surgical removal of the posterior cauterized tissue to achieve healing by primary intention. This technique was performed on 30 patients with onychocryptosis affecting the great toe (Mozena stages I and IIa), and all of the patients were followed up postoperatively for 12 months. The patients reported minimal postoperative pain, quicker surgical postoperative healing, rapid return to activities of daily living, and minor postoperative recurrence compared with previous studies using incisional procedures and chemical matrixectomies.


Assuntos
Terapia a Laser/métodos , Unhas Encravadas/cirurgia , Adolescente , Adulto , Idoso , Criança , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Unhas/cirurgia , Procedimentos Ortopédicos/métodos , Complicações Pós-Operatórias , Recuperação de Função Fisiológica , Dedos do Pé/cirurgia , Adulto Jovem
5.
BMC Cancer ; 19(1): 1002, 2019 Oct 25.
Artigo em Inglês | MEDLINE | ID: mdl-31653251

RESUMO

BACKGROUND: Amputation is the standard of care even for early-stage subungual melanomas (SUMs), known as nail apparatus melanoma, because the nail bed and nail matrix are close to the distal phalanx. However, a recent study demonstrated that not all patients with SUMs had histologic invasion of the underlying distal phalanx. As most SUMs occur in the thumb or big toe, amputation of either the thumb or big toe substantially interferes with activities of daily living, including poor cosmesis, loss of function, and phantom pain. Non-amputative digit preservation surgery can thus be applied in such cases without compromising patient prognosis. METHODS: We are conducting a multi-institutional single-arm trial to confirm the safety and efficacy of non-amputative digit preservation surgery. We will compare our results with those reported in the Japanese Melanoma Study, in which patients underwent amputation for SUMs as a traditional standard of care. Patients aged between 20 and 80 years with stage I, II, or III without evidence of tumor invasion to the underlying distal phalanx on preoperative radiograph are included in the study. The primary endpoint is major relapse-free survival (major RFS), which does not include local recurrence as an event; secondary endpoints include overall survival, digit-preservation survival, relapse-free survival, local relapse-free survival, partial relapse-free survival, and incidence of adverse events. A total of 85 patients from 21 Japanese institutions will be recruited within 5.5 years, and the follow-up period will last at least 5 years. The Japan Clinical Oncology Group Protocol Review Committee approved this study protocol in August 2017, and patient enrollment began in November 2017. Ethical approval was obtained from each institution's Institutional Review Board prior to patient enrollment. DISCUSSION: This is the first prospective trial to confirm the safety and efficacy of non-amputative digit preservation surgery for SUM without distant metastasis or bony invasion. The results of this trial could provide evidence to support this less-invasive surgery as a new standard of care to preserve adequately functioning digits. TRIAL REGISTRATION: Registry number: UMIN000029997 . Date of Registration: 16/Nov/2017. Date of First Participant Enrollment: 12/Dec/2017.


Assuntos
Melanoma/epidemiologia , Melanoma/cirurgia , Procedimentos Cirúrgicos Minimamente Invasivos/efeitos adversos , Procedimentos Cirúrgicos Minimamente Invasivos/métodos , Doenças da Unha/epidemiologia , Doenças da Unha/cirurgia , Atividades Cotidianas , Adulto , Idoso , Idoso de 80 Anos ou mais , Amputação/efeitos adversos , Amputação/métodos , Intervalo Livre de Doença , Feminino , Seguimentos , Humanos , Incidência , Japão/epidemiologia , Masculino , Oncologia/métodos , Pessoa de Meia-Idade , Recidiva Local de Neoplasia , Prognóstico , Estudos Prospectivos , Polegar/patologia , Polegar/cirurgia , Dedos do Pé/patologia , Dedos do Pé/cirurgia , Adulto Jovem
6.
Clin Podiatr Med Surg ; 36(4): 651-661, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31466573

RESUMO

Lesser digit deformities that require surgical intervention may be corrected by interphalangeal arthrodesis. The traditional fixation device used to stabilize an interphalangeal arthrodesis is a smooth Kirschner wire (K-wire). Its use, however, has been associated with risks. The K-wires are known to migrate and break, and there are increased risks of pin tract infection. Choices for digital implants include nonresorbable, resorbable, and allograft. There are more than 60 newer intramedullary fixation devices available for use in digital surgery. Intramedullary implants also have their own inherent risks. Further research into patient outcomes and cost-effectiveness of these new devices is still needed.


Assuntos
Artrodese/instrumentação , Fios Ortopédicos , Próteses e Implantes , Articulação do Dedo do Pé/cirurgia , Dedos do Pé/cirurgia , Humanos , Transplante Homólogo
7.
Vasc Endovascular Surg ; 53(7): 606-608, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31272303

RESUMO

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.


Assuntos
Materiais Revestidos Biocompatíveis/efeitos adversos , Embolia/etiologia , Úlcera do Pé/etiologia , Migração de Corpo Estranho/etiologia , Isquemia/etiologia , Polímeros/efeitos adversos , Dedos do Pé/irrigação sanguínea , Idoso de 80 Anos ou mais , Amputação , Angiografia , Biópsia , Embolia/diagnóstico por imagem , Embolia/cirurgia , Feminino , Úlcera do Pé/diagnóstico por imagem , Úlcera do Pé/fisiopatologia , Úlcera do Pé/cirurgia , Migração de Corpo Estranho/diagnóstico por imagem , Migração de Corpo Estranho/cirurgia , Humanos , Interações Hidrofóbicas e Hidrofílicas , Isquemia/diagnóstico por imagem , Isquemia/fisiopatologia , Isquemia/cirurgia , Fluxo Sanguíneo Regional , Dedos do Pé/cirurgia , Resultado do Tratamento
8.
Diabetes Metab Syndr ; 13(2): 959-963, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31336551

RESUMO

BACKGROUND AND AIM: Diabetic foot is a major comorbidity of diabetes, with 15-25% of diabetic patients developing diabetic foot ulcer during their lifetime. Other major diabetic foot complications include cellulitis, abscess, wet gangrene, dry gangrene, and necrotizing fasciitis. Dry gangrene involves tissue necrosis due to chronic ischemia whereby the tissue becomes numb, dry, wrinkled, and dead. Although diabetic foot complications have been extensively studied in literature, there is limited data on the management of dry gangrene. METHODS: We report a case series of 12 patients with diabetes-related dry gangrene in the toes, initially planned to be managed conservatively with autoamputation. RESULTS: One patient had an autoamputation, while eight patients underwent surgical amputations (six major amputations, two minor amputations) for better clinical outcomes. Two patients died, while no change was observed in one patient even after 12 months of follow-up. CONCLUSION: Managing diabetic dry toe gangrene by waiting for autoamputation may lead to worse clinical outcomes and should be practiced cautiously on a case-by-case basis. Early surgical intervention should be opted to improve patients' quality of life.


Assuntos
Amputação/estatística & dados numéricos , Diabetes Mellitus Tipo 2/fisiopatologia , Pé Diabético/complicações , Gangrena/cirurgia , Osteomielite/fisiopatologia , Qualidade de Vida , Dedos do Pé/cirurgia , Idoso , Feminino , Seguimentos , Gangrena/epidemiologia , Gangrena/etiologia , Humanos , Masculino , Pessoa de Meia-Idade , Prognóstico , Estudos Retrospectivos , Arábia Saudita/epidemiologia , Cicatrização
9.
BMJ Case Rep ; 12(7)2019 Jul 12.
Artigo em Inglês | MEDLINE | ID: mdl-31302625

RESUMO

Toe necrosis has many aetiologies. The most common one is ischaemia. In fact, both direct and indirect toe necrosis, as well as related lower limb gangrene, could be secondary to mechanical trauma, infections, pharmacological sensitivity, cancer, blue toe syndrome and other granulomatous diseases. We report a case of toes necrosis caused by an uncommon aetiology.


Assuntos
Angiopatias Diabéticas/complicações , Doenças do Pé/etiologia , Gangrena/etiologia , Fumar Maconha/efeitos adversos , Amputação , Humanos , Masculino , Dedos do Pé/cirurgia , Adulto Jovem
10.
Plast Reconstr Surg ; 144(1): 149-154, 2019 07.
Artigo em Inglês | MEDLINE | ID: mdl-31246822

RESUMO

BACKGROUND: Conventional dogma suggests that the use of local anesthetic with epinephrine is contraindicated in the digits because of fear of ischemia and necrosis. Although several reports have refuted this notion, the precept is still propagated in many clinical forums. For many years, the authors have used lidocaine with epinephrine to perform removal of postaxial polydactyly in infants and have observed few complications and no cases of digital ischemia or necrosis. This investigation details the authors' outcomes with this anesthetic modality in neonates and supports the growing body of literature documenting the safety of using lidocaine with epinephrine in the digits. METHODS: A retrospective review of all infants younger than 6 months who underwent preaxial and postaxial polydactyly excision and removal of their sequelae of the hand or foot under local anesthesia, from 2011 to 2017, was completed. All demographic characteristics, frequency of complications, and descriptive statistics of the sample clinical group were documented. RESULTS: In the 215 patients who met inclusion criteria, a total of 402 procedures were performed. Mean follow-up was 19.9 months for 140 patients, or 264 procedures (65.7 percent). The total complication rate was 2.6 percent. There were two cases of minor bleeding, one wound dehiscence, and four surgical-site infections. CONCLUSIONS: In 402 procedures of surgical excision of polydactyly in infants, there were few short-term complications, none of which were necrosis or any vascular complication related to the use of epinephrine. The authors believe that, with the use of a low-dose epinephrine injection (1:200,000), the risk for digital infarction is low in this population. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, IV.


Assuntos
Epinefrina/efeitos adversos , Polidactilia/cirurgia , Vasoconstritores/efeitos adversos , Anestésicos Locais/administração & dosagem , Quimioterapia Combinada , Epinefrina/administração & dosagem , Feminino , Dedos/anormalidades , Dedos/cirurgia , Humanos , Lactente , Recém-Nascido , Masculino , Bloqueio Nervoso/métodos , Complicações Pós-Operatórias/etiologia , Estudos Retrospectivos , Dedos do Pé/anormalidades , Dedos do Pé/cirurgia , Vasoconstritores/administração & dosagem
11.
Acta Orthop Traumatol Turc ; 53(4): 306-309, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31104884

RESUMO

OBJECTIVE: Hair tourniquet syndrome is an uncommon condition characterized by strangulation appendages by a hair or thread. The aim of this study was to evaluate the results of hair removal and antibiotic therapy in our patients with hair tourniquet syndrome. METHODS: Between January 2012 and August 2018, 16 patients (8 boys, 8 girls; mean age: 118.5 [range: 20 to 380] days) were treated surgically for hair tourniquet syndrome. All patients were treated surgically under local or general anesthesia in the pediatric emergency department or in the operating theater using magnifying loupes. The age, gender, affected fingers or toes and the affected sides of the patients and the duration of symptoms until presentation were recorded. RESULTS: A total of 24 toes and fingers were treated for hair tourniquet syndrome. The right side was affected in 12 patients, the left side was affected in three, and both sides in one. The second toe was affected in three patients, the third toe in eleven, the fourth in six, and the fifth in two patients. Both the thumb and the second finger were affected in one patient. The average duration of the symptoms (excessive crying, swelling, redness) was 1.5 (range: 1 to 2) days. All patients healed without any complications. CONCLUSION: Hair tourniquet syndrome should be kept in mind as an etiology in infants with toe and finger strangulation. These patients should be examined undressed. Immediate removal of hair is an effective treatment method to save appendage. LEVEL OF EVIDENCE: Level IV, Therapeutic Study.


Assuntos
Traumatismos dos Dedos , Dedos , Isquemia/prevenção & controle , Dedos do Pé , Constrição Patológica/diagnóstico , Constrição Patológica/etiologia , Constrição Patológica/cirurgia , Serviço Hospitalar de Emergência , Feminino , Traumatismos dos Dedos/diagnóstico , Traumatismos dos Dedos/etiologia , Traumatismos dos Dedos/cirurgia , Dedos/irrigação sanguínea , Dedos/patologia , Dedos/cirurgia , Cabelo , Humanos , Lactente , Masculino , Síndrome , Tempo para o Tratamento , Dedos do Pé/irrigação sanguínea , Dedos do Pé/lesões , Dedos do Pé/patologia , Dedos do Pé/cirurgia , Resultado do Tratamento
12.
Int J Low Extrem Wounds ; 18(2): 200-207, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-30968713

RESUMO

Diabetic foot gangrene with lower extremity ischemia can preclude amputation. However, wound treatment principles based on the Wagner classification system are lacking. We proposed the STAGE principle for the surgical management of diabetic foot wounds. The STAGE principle guides surgical intervention during the wound treatment of diabetic foot ulcers and emphasizes that "based on anatomical layers, the management focuses on blood supply and includes layer-by-layer incision to the infected area, maintenance of effective wound drainage, and step-by-step treatment of the wound." We applied the STAGE principle for the treatment of 7 patients with an ankle brachial index <0.5 and Wagner grade 4 diabetic foot gangrene. The average ankle brachial index was 0.42 (0.32-0.48; SD = 0.06), and male patients smoked an average of 1.28 packs/day (0.4-2; SD = 0.63). The average wound duration was 45.86 days (14-63 days; SD = 18.46). The average wound healing time was 8.86 months (5-13 months; SD = 2.36). The follow-up time was 37.71 months (3-84 months; SD = 25.04; median = 36 months). Patient 1 received endovascular interventional therapy twice for the lower extremity artery, and the wound healed. After 3 months of follow-up, the patient exhibited recurrence. After the third application of endovascular interventional therapy for the lower extremity artery, the blood supply was improved, and the wound healed after 1 month. In summary, the treatment of 7 cases of diabetic foot gangrene with severe lower extremity ischemia using the STAGE principle resulted in remarkable efficacy.


Assuntos
Amputação/métodos , Pé Diabético/cirurgia , Procedimentos Endovasculares/métodos , Gangrena/cirurgia , Isquemia/cirurgia , Guias de Prática Clínica como Assunto , Cicatrização/fisiologia , Idoso , China , Estudos de Coortes , Desbridamento/métodos , Diabetes Mellitus/diagnóstico , Diabetes Mellitus/epidemiologia , Pé Diabético/diagnóstico , Pé/cirurgia , Gangrena/diagnóstico , Humanos , Isquemia/fisiopatologia , Perna (Membro)/cirurgia , Salvamento de Membro , Masculino , Pessoa de Meia-Idade , Prognóstico , Estudos Retrospectivos , Dedos do Pé/cirurgia , Resultado do Tratamento
13.
J Foot Ankle Res ; 12: 13, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30815036

RESUMO

Background: Descriptions of the techniques for condylectomies via minimally invasive surgery (MIS) to treat interdigital helomas of the lesser toes are scarce in the literature. This study aimed to define and describe this surgical technique. Methods: This observational study was performed using the Delphi method. We collected the anonymous opinions of a multidisciplinary international panel of ten experts by answering a 43-items questionnaire via e-mail. Statements with an average score ≥ 3 were included in the next round, as were those in which none of the three statements reached the minimum score of 3 within the same item. Results: Response rate: 90%. Three rounds were needed to reach consensus on proposed items. A new statement that combined two statements was proposed in round 3. Eleven recommendations regarding the incision and instruments used to perform this surgical technique were obtained based on the expert consensus. Conclusions: A longitudinal incision to the distal pulp of the toe or an incision to the centre of the plantar aspect of the head of the proximal phalanx should be performed according to the affectation, and a Beaver 64 scalpel blade, a blunt elevator and a Shannon-Isham burr are the most acceptable tools for this kind of surgery.


Assuntos
Calosidades/cirurgia , Osteotomia/métodos , Dedos do Pé/cirurgia , Anestesia Local/métodos , Técnica Delfos , Humanos , Procedimentos Cirúrgicos Minimamente Invasivos/métodos
14.
Unfallchirurg ; 122(4): 309-322, 2019 Apr.
Artigo em Alemão | MEDLINE | ID: mdl-30847497

RESUMO

Metatarsal and toe fractures are the most frequent injuries of the foot skeleton. Nondislocated fractures can be conservatively treated with good success. Long-term relief and immobilization including the ankle joint are unnecessary. Metatarsal fractures close to the base are nearly always associated with Lisfranc luxation and treatment must also take the instability of the tarsometatarsal joints into consideratíon. Basal fractures of the 5th metatarsal bone require a differentiated consideration. The correct classification is necessary in order to initiate an adequate treatment. In general, intra-articular layer formation, inclination >10° and shortening between 3 mm and 5 mm, taking the position of the head of the metatarsal bone into consideration, are recommended as indications for surgery. Operative treatment of toe fractures is only rarely necessary.


Assuntos
Traumatismos do Pé/cirurgia , Fraturas Ósseas/cirurgia , Ossos do Metatarso/lesões , Dedos do Pé/lesões , Traumatismos do Pé/classificação , Fixação Interna de Fraturas , Fraturas Ósseas/classificação , Humanos , Ossos do Metatarso/cirurgia , Dedos do Pé/cirurgia
18.
J Foot Ankle Surg ; 58(3): 586-590, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-30745269

RESUMO

Macrodactylism or macrodactyly is referred to as congenital deformity of fingers or toes, and the corresponding incidence rate is relatively low. In this article, we describe a young male with macrodactylism of the second toe of his right foot. He was suffering from persistent pain, overgrowth, and hyperhidrosis ofthe involved toe. Radiographic examination of the right foot showed a small translucent area surrounded by hyperplasia and sclerotic bone in the second distal phalanx, in addition to increased soft tissue density and volume. Surgical resection of the bone lesion and reduction of the soft tissue bulk were performed. Pathological findings showed osteoblast hyperplasia, which was diagnosed as osteoid osteoma, and noabnormal findings were seen in the skin. Symptoms of pain and hyperhidrosis disappeared postsurgery and did not recur over the subsequent 2-year follow-up. As far as we know, this was a rare case of osteoid osteoma occurring in the toe that resulted in macrodactylism, which was also associated with localized hyperhidrosis.


Assuntos
Neoplasias Ósseas/cirurgia , Deformidades Adquiridas do Pé/etiologia , Hiperidrose/etiologia , Osteoma Osteoide/cirurgia , Dedos do Pé/anormalidades , Neoplasias Ósseas/patologia , Criança , Deformidades Adquiridas do Pé/cirurgia , Humanos , Masculino , Osteoma Osteoide/patologia , Dedos do Pé/cirurgia
19.
Medicine (Baltimore) ; 98(3): e14190, 2019 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-30653171

RESUMO

RATIONALE: Cervical cancer is one of the most common gynecologic malignancies worldwide, and it spreads mainly through direct extension. Distinct metastases are less common and usually spread to distant lymph nodes, lungs, and bones. Bone metastases from cervical cancer are most commonly observed in the pelvis and spine. Thus, a pathological toe fracture as the initial presentation of cervical cancer is extremely rare. PATIENT CONCERNS: We report a patient with a toe metastasis that first presented with pain caused by a pathological fracture. DIAGNOSES: The patient underwent surgery to remove the right great toe, and the histopathology revealed squamous carcinoma that originated from the cervix. INTERVENTIONS: The patient then underwent cervical cancer surgery, chemotherapy, and radiotherapy. LESSONS: A pathological toe fracture as the initial presentation of cervical cancer is extremely rare, but clinicians need to be aware that we should not exclude cancer when patients come to the hospital for pathological fractures.


Assuntos
Neoplasias Ósseas/secundário , Carcinoma de Células Escamosas/patologia , Fraturas Espontâneas/etiologia , Dedos do Pé/patologia , Neoplasias do Colo do Útero/patologia , Adulto , Carcinoma de Células Escamosas/terapia , Feminino , Humanos , Dedos do Pé/cirurgia , Tomografia Computadorizada por Raios X , Neoplasias do Colo do Útero/diagnóstico , Neoplasias do Colo do Útero/terapia
20.
J Plast Reconstr Aesthet Surg ; 72(5): 729-736, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-30595416

RESUMO

Combination foot flaps for digit reconstruction was previously introduced by our group as an alternative method for toe-to-hand transfer. The aim of this study was to analyze our experience with the combination foot flaps and to present the surgical refinements that were introduced. A prospective study was conducted including all combination foot flaps performed at our hospital since September 2009. Surgical refinements that were introduced during this study included island flap for repair of toenail donor site and the use of Z-plasty. The median operation duration was 6.7 hours (range 3.5-13 h). Among 74 flaps, partial necrosis occurred in three flaps (4.1%); two palmar flaps (2.7%) were bulky. Among 37 cases of reconstructed digits, contracture of the first web occurred in one case (1.4%). All the patients were able to walk well and did not complain of any pain or cold intolerance. Wound dehiscence of donor site was observed in three patients (8.1%). Toenail deformity occurred in one case (2.7%). The combination foot flap is a reliable option for digit reconstruction with minimal donor site complications.


Assuntos
Dedos/cirurgia , Pé/cirurgia , Retalhos de Tecido Biológico/transplante , Procedimentos Cirúrgicos Reconstrutivos/métodos , Dedos do Pé/cirurgia , Adolescente , Adulto , Criança , Feminino , Traumatismos dos Dedos/cirurgia , Humanos , Masculino , Pessoa de Meia-Idade , Duração da Cirurgia , Recuperação de Função Fisiológica , Estudos Retrospectivos , Dedos do Pé/lesões , Adulto Jovem
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