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1.
Surg Clin North Am ; 100(4): 707-725, 2020 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-32681871

RESUMO

Chronic wounds often are the result of bone deformities, compounded by musculotendinous and ligamentous imbalance. Sensory neuropathy places patients at greater risk for acute wounds to develop into chronic wounds. Etiologies of these deforming forces include Charcot neuroarthropathy, trauma, and congenital and acquired neuromuscular disorders. Management of these deformities ranges from simple relief of pressure with soft inserts to bracing for mechanical instability. Correction of more complex deformities requires resection of bone, osteotomies, fusions, and external fixation. Tendon and ligament imbalance must be addressed at all levels of deformity. Postoperatively, patients must be re-evaluated for continuation of orthoses and bracing.


Assuntos
Articulação do Tornozelo/cirurgia , Pé/cirurgia , Cicatrização/fisiologia , Ferimentos e Lesões/cirurgia , Traumatismos do Tornozelo/fisiopatologia , Traumatismos do Tornozelo/cirurgia , Braquetes , Doença Crônica , Desbridamento , Desenho de Equipamento , Traumatismos do Pé/fisiopatologia , Traumatismos do Pé/cirurgia , Humanos , Aparelhos Ortopédicos , Osteomielite/fisiopatologia , Osteomielite/cirurgia , Lesões dos Tecidos Moles/cirurgia , Retalhos Cirúrgicos , Tendinopatia/fisiopatologia , Tendinopatia/cirurgia , Ferimentos e Lesões/fisiopatologia
2.
Orthop Clin North Am ; 51(3): 325-338, 2020 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-32498951

RESUMO

Minimally invasive surgical techniques are increasingly used for definitive treatment of displaced intra-articular calcaneal fractures. These approaches have been shown to minimize soft tissue injury, preserve blood supply, and decrease operative time. These methods can be applied to all calcaneal fractures and have particular advantages in patients with higher than usual risks to the soft tissues. The literature suggests that results of limited soft tissue dissection approaches provide equivalent outcomes to those obtained with the extensile lateral approach. We predict that as imaging and other techniques continue to improve, more calcaneal fractures will be treated by these appealing safer techniques.


Assuntos
Calcâneo/lesões , Calcâneo/cirurgia , Traumatismos do Pé/cirurgia , Fixação Interna de Fraturas/métodos , Fraturas Ósseas/cirurgia , Fraturas Intra-Articulares/cirurgia , Humanos , Procedimentos Cirúrgicos Minimamente Invasivos/métodos , Posicionamento do Paciente
4.
Vet Surg ; 49(1): 88-95, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31433505

RESUMO

OBJECTIVE: To determine long term outcomes of nonracing equines athletes treated for short incomplete proximal sagittal fractures of the proximal phalanx (SIPSFP1) by lag screw fixation. STUDY DESIGN: Retrospective study. SAMPLE POPULATION: Thirty-one horses. METHODS: Medical records from horses with an SIPSFP1 (2008-2014) were reviewed. Long-term (≥12 months) outcomes were assessed with telephone interviews and clinical and radiographic examinations. RESULTS: Warmblood was the predominant breed in cases included in the study. Among horses with long-term interview information, 27 of 31 returned to previous athletic activity level. In total, 15 horses with 19 fractures had clinical and radiographic assessment after a minimum of 12 months. Among those, nine of 15 horses were sound at the trot, and six of 15 were mildly lame. Complete radiographic healing was confirmed in six limbs, and the facture line was evident in 13. The position of the proximal screw was not associated with radiographic fracture healing or return to soundness. CONCLUSION: Most horses treated for SIPSFP1 with lag screw fixation returned to previous activity levels, although radiographic fracture healing remained incomplete 12 months or more after surgery. CLINICAL SIGNIFICANCE: Lag screw fixation is a valid treatment for horses not used for racing that are experiencing an SIPSFP1 and results in a high rate of return to intended use, although complete radiographic fracture healing cannot be expected.


Assuntos
Parafusos Ósseos/veterinária , Traumatismos do Pé/veterinária , Fraturas Ósseas/veterinária , Casco e Garras , Cavalos/lesões , Animais , Feminino , Traumatismos do Pé/cirurgia , Consolidação da Fratura , Fraturas Ósseas/diagnóstico por imagem , Fraturas Ósseas/cirurgia , Cavalos/cirurgia , Estudos Longitudinais , Masculino , Condicionamento Físico Animal , Registros/veterinária , Estudos Retrospectivos , Resultado do Tratamento
5.
J Foot Ankle Surg ; 59(1): 112-116, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-31882133

RESUMO

Turf toe is hyperextension injury of the plantar plate at the first metatarsophalangeal joint. Etiologies have often included sports/activities with excessive forefoot axial loading and/or violent pivotal movements. The purpose of the systematic review was to systematically review and present an overview for the current evidence-based treatment options of turf toe. Both authors systematically reviewed the PubMed and EMBASE databases from inception to April 2016 based on the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. The level of evidence and quality of evidence were assessed by using the Level of Evidence for Primary Research Question of the Journal of Bone and Joint Surgery, and the quality of evidence was assessed with use of the Newcastle-Ottawa scale. Data were collected and categorized into: case reports and case series. Eight studies (16 turf toes) met the aforementioned criteria and were included. Five case reports and 3 case series reported various treatment options for turf toe. Specifically, 3 studies reported solely conservative treatment (n = 5), 1 study reported solely surgical treatment (n = 1), and 4 studies involved patients in conservative and/or surgical treatments (n = 10). All studies were of level of clinical evidence 4 and quality of clinical evidence score 2 (poor quality). Conservative treatment included closed reduction and immobilization, and surgical treatment included plantar plate tenodesis. Restricted dorsiflexion was the most common complication reported. Turf toe is an underreported injury with no evidence-based treatment guideline to date. Future studies of higher level and quality of evidence with a specific classification system (Jahss or Anderson) consistently reported are warranted for the development of an optimal guideline to determine the most appropriate treatment for each specific severity in injury.


Assuntos
Traumatismos em Atletas/terapia , Traumatismos do Pé/terapia , Placa Plantar/lesões , Traumatismos em Atletas/cirurgia , Traumatismos do Pé/cirurgia , Antepé Humano/lesões , Antepé Humano/cirurgia , Humanos , Articulação Metatarsofalângica/lesões , Articulação Metatarsofalângica/cirurgia , Placa Plantar/cirurgia , Suporte de Carga
6.
J Foot Ankle Surg ; 59(1): 128-130, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-31882136

RESUMO

Damage to the weightbearing surface of the foot is a challenge for the reconstructive surgeon. The aim is to reconstruct the skeletal tripod and soft tissue, allowing the patient to walk normally. We report the case of a patient admitted with an acute right foot open fracture of the second, third, fourth, and fifth metatarsal bones. After debridement of all nonvital tissues, the patient required reconstruction of the metatarsal heads (third, fourth, and fifth) plus soft tissue coverage. We then performed a reconstruction with a free osteocutaneous fibular flap, insetting the bone perpendicular to the long axis of the metatarsal bones. This configuration allowed the reconstruction of the foot skeletal tripod. A second free flap, a thin radial forearm flap, was added during the revision surgery to improve the venous drainage of the skin paddle of the fibular flap and avoid tension after skin closure. At 1-year follow-up, the patient was able to walk entirely weightbearing on the forefoot, returning to her previous employment with no limitation in physical and recreational activities. To our knowledge, this is the first description of the use of a chimeric osteocutaneous fibular flap, oriented transversely, to reconstruct a complex bone/soft tissue defect after a traumatic loss of multiple metatarsal heads.


Assuntos
Fíbula/transplante , Traumatismos do Pé/cirurgia , Fraturas Expostas/cirurgia , Retalhos de Tecido Biológico/irrigação sanguínea , Ossos do Metatarso/cirurgia , Lesões dos Tecidos Moles/cirurgia , Transplante Ósseo , Desbridamento , Feminino , Seguimentos , Traumatismos do Pé/diagnóstico por imagem , Fraturas Cominutivas/diagnóstico por imagem , Fraturas Cominutivas/cirurgia , Fraturas Expostas/diagnóstico por imagem , Retalhos de Tecido Biológico/cirurgia , Humanos , Ossos do Metatarso/diagnóstico por imagem , Ossos do Metatarso/lesões , Rádio (Anatomia)/transplante , Procedimentos Cirúrgicos Reconstrutivos/métodos , Recuperação de Função Fisiológica , Lesões dos Tecidos Moles/diagnóstico por imagem , Suporte de Carga , Adulto Jovem
7.
J Foot Ankle Surg ; 59(1): 142-148, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-31882137

RESUMO

Total calcaneus and talus loss in the hindfoot is an unusual but severe condition encountered in clinical settings. This condition affects lower-extremity function and poses a significant challenge to limb salvage. We present a case of a 43-year-old man with total calcaneus and talus loss in the right foot treated by Ilizarov technique. A staged treatment protocol was planned to reconstruct and optimize the heel for weightbearing and walking. During the 15-month postoperative follow-up, the patient reported no significant discomfort in the targeted foot and regained satisfactory function, including shoe wearing, walking, driving, and climbing stairs. The American Orthopaedic Foot and Ankle Society Ankle-Hindfoot Scale score was 71, which was an improvement from a preoperative score of 40. This case is the first reported on the functional reconstruction by Ilizarov technique of hindfoot with total calcaneus and talus loss. This treatment protocol provides an effective approach to reconstructing the hindfoot with massive bone loss, although the long-term outcome remains unknown.


Assuntos
Calcâneo/cirurgia , Deformidades Adquiridas do Pé/cirurgia , Traumatismos do Pé/cirurgia , Técnica de Ilizarov , Procedimentos Cirúrgicos Reconstrutivos/métodos , Tálus/cirurgia , Adulto , Traumatismos por Explosões/complicações , Traumatismos por Explosões/cirurgia , Calcâneo/lesões , Deformidades Adquiridas do Pé/diagnóstico por imagem , Deformidades Adquiridas do Pé/etiologia , Traumatismos do Pé/diagnóstico por imagem , Traumatismos do Pé/etiologia , Calcanhar/diagnóstico por imagem , Calcanhar/lesões , Calcanhar/cirurgia , Humanos , Imageamento Tridimensional , Salvamento de Membro , Masculino , Recuperação de Função Fisiológica , Tálus/lesões , Tomografia Computadorizada por Raios X , Resultado do Tratamento
8.
J Foot Ankle Surg ; 59(1): 195-200, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-31882140

RESUMO

Surgical repair of complete plantar fascia ruptures has not yet been reported in the literature. Operative technique and outcome are described in 2 gymnasts with heavy plyometric demands who received surgical repair compared with 3 athletes treated nonoperatively. Biomechanics and clinical implications are discussed. In the last 8 years, we have seen 5 high-demand athletes with total rupture of the plantar fascia. This is a retrospective clinical evaluation 1.5 to 8 years postinjury of all 5 patients using dynamic ultrasound, Foot Function Index, sports-specific questions, Foot Posture Index, and foot length. The operated gymnasts returned to the same level of performance within 12 months. None of the conservatively treated athletes returned to preinjury plyometric sports levels but reached a foot load capacity of distance running with the injured foot as limiting factor. Ultrasound with simultaneous dorsiflexion of the toes showed a normal fascia in the operated patients, but a slack fascia that tightened up only at terminal toe dorsiflexion in the conservatively treated group. According to the Foot Function Index, the operated patients reported no complaints, whereas the nonoperative group had clinical relevant impairments in activities of daily life. The Foot Posture Index in all nonoperated patients showed a relative shift toward pronation with increased foot length compared with the noninjured foot. The operated patients showed no difference in foot length but minimal shift into supination with a slightly altered arch contour. Surgical repair of plantar fascia ruptures is technically feasible to restore normal foot load capability with return to high-demand plyometric sports within 12 months.


Assuntos
Traumatismos em Atletas/cirurgia , Fáscia/lesões , Traumatismos do Pé/cirurgia , Pé/cirurgia , Antepé Humano/lesões , Antepé Humano/cirurgia , Adulto , Feminino , Traumatismos do Pé/etiologia , Humanos , Masculino , Ruptura , Adulto Jovem
9.
J Orthop Surg Res ; 14(1): 359, 2019 Nov 12.
Artigo em Inglês | MEDLINE | ID: mdl-31718674

RESUMO

BACKGROUND: Socio-demographic factors have been suggested to contribute to differences in healthcare utilization for several elective orthopedic procedures. Reports on disparities in utilization of orthopedic trauma procedures remain limited. The purpose of our study is to assess the roles of clinical and socio-demographic variables in utilization of operative fixation of calcaneus fractures in the USA. METHODS: The National Inpatient Sample (NIS) dataset was used to analyze all patients from 2005 to 2014 with closed calcaneal fractures. Multivariate logistic regression analyses were performed to evaluate the impact of clinical and socio-demographic variables on the utilization of surgical versus non-surgical treatment. RESULTS: A total of 17,156 patients with closed calcaneus fractures were identified. Operative treatment was rendered in 7039 patients (41.03%). A multivariate logistic regression demonstrated multiple clinical and socio-demographic factors to significantly influence the utilization of surgical treatment including age, gender, insurance status, race/ethnicity, income, diabetes, peripheral vascular disease, psychosis, drug abuse, and alcohol abuse (p <  0.05). In addition, hospital size and hospital type (teaching versus non-teaching) showed a statistically significant difference (p <  0.05). CONCLUSIONS: Besides different clinical variables, we identified several socio-demographic factors influencing the utilization of surgical treatment of calcaneus fractures in the US patient population. Further studies need to identify the specific patient-related, provider-related, and system-related factors leading to these disparities.


Assuntos
Calcâneo/lesões , Traumatismos do Pé/cirurgia , Fixação Interna de Fraturas/estatística & dados numéricos , Fraturas Fechadas/cirurgia , Disparidades em Assistência à Saúde/etnologia , Adulto , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Estados Unidos
10.
Foot (Edinb) ; 40: 109-115, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31675679

RESUMO

The use of single photon emission computer tomography (SPECT/CT) in acute vascular injury is not well documented. SPECT/CT combines the anatomic detail of computer tomography with the functional vascular perfusion of photon emission to determine the viability of osseous structures and surrounding soft tissue. The superimposed imaging provides the practitioner with a reliable anatomic image of viability of a specific anatomic area following insult or injury. We present two cases, bilateral lower extremity frostbite, and symmetric peripheral gangrene in which this imaging modality provided guidance for surgical intervention with adequate predictability and results.


Assuntos
Traumatismos do Pé/diagnóstico por imagem , Traumatismos do Pé/cirurgia , Congelamento das Extremidades/diagnóstico por imagem , Congelamento das Extremidades/cirurgia , Gangrena/diagnóstico por imagem , Gangrena/cirurgia , Tomografia Computadorizada de Emissão de Fóton Único , Tomografia Computadorizada por Raios X , Adulto , Idoso , Amputação , Humanos , Masculino , Imagem Multimodal
11.
Foot Ankle Spec ; 12(4): 310, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31526087
12.
Clin Orthop Surg ; 11(3): 325-331, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31475054

RESUMO

Background: It is difficult for surgeons to reconstruct soft tissue defects of the great toe. This report aims to evaluate the utility and efficacy of innervated distally based first dorsal metatarsal artery (FDMA) flap with a wide pedicle for reconstruction of soft tissue defects of the great toe. Methods: This is a retrospective report. Between January 2015 and December 2017, six cases of skin defect of the great toe were reconstructed with an innervated distally based FDMA flap with a wide pedicle. One case was excluded in this report because of chronic pain on the metatarsophalangeal joint due to osteoarthritis before the injury. A total of five cases were evaluated for flap survival and sensory recovery. The sensory recovery was investigated by two-point discrimination and Semmes-Weinstein monofilament tests. The average age of the selected patients was 40 years (range, 36 to 56 years), and the average size of the defect in the toe was 8.3 cm2 (range, 4 to 13.8 cm2). The average follow-up period was 29.4 months (range, 18 to 38 months). Results: All patients survived without any complications. The average two-point discrimination test value was 8.0 ± 0.89 mm (range, 7 to 9 mm), and the average value obtained from the Semmes-Weinstein monofilament test was 4.53 ± 0.33 (range, 4.17 to 4.93). The average residual pain score evaluated with a visual analog scale was 1 (range, 0 to 2). Two patients complained of stiffness in the great toe below 30° of total range of motion during the early stages after surgery, but this stiffness gradually improved after rehabilitation. The average range of motion of three patients with a remaining metatarsophalangeal joint after surgery was 80° (range, 70° to 90°). All five cases could walk regularly without any unique footwear at the final follow-up. Conclusions: The innervated distally based FDMA flap with a wide pedicle could be a good alternative method for repair of soft tissue defects of the great toe.


Assuntos
Traumatismos do Pé/cirurgia , Hallux/lesões , Hallux/cirurgia , Lesões dos Tecidos Moles/cirurgia , Retalhos Cirúrgicos/irrigação sanguínea , Retalhos Cirúrgicos/inervação , Adulto , Feminino , Traumatismos do Pé/etiologia , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Lesões dos Tecidos Moles/etiologia
13.
Ulus Travma Acil Cerrahi Derg ; 25(5): 474-478, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31475318

RESUMO

BACKGROUND: The incidence of motorcycle-induced spoke wheel injury is on the rise in our set up. These injuries range from minor soft tissue laceration to extensive crush injuries. This study aimed to evaluate the mechanism, characteristics, incidence and management of wheel spoke injuries. METHODS: Data of all children admitted to Pediatric Surgery Emergency from January 2014 to December 2017, presenting with wheel spoke injuries were analyzed. Incidence, mechanism and characteristics of injury, along with management plan, were noted. The outcomes were assessed by evaluating patients in follow up. RESULTS: Total study patients were 120, with an incidence of 21.7%. Mean age was 8.03±2.28 years. There were 101male patients and nine female patients. All patients were passengers and were sitting astride. Most of the patients were wearing shoes, and hindfoot area of the right foot was mainly involved. Grade 2 injury was seen in 55 (45.8%) and Grade 3 in 55 (45.8%) patients. Flap was needed in 27(22.5%) patients. All patients were mobile at the time of the follow-up. CONCLUSION: We noted the rising incidence of entrapment injuries; however, we had a satisfactory outcome in our patients using different management techniques. We recommend the implementation of safety protocols to avoid such catastrophic injuries.


Assuntos
Acidentes de Trânsito , Traumatismos do Pé , Motocicletas , Acidentes de Trânsito/prevenção & controle , Acidentes de Trânsito/estatística & dados numéricos , Criança , Pré-Escolar , Feminino , Seguimentos , Traumatismos do Pé/epidemiologia , Traumatismos do Pé/prevenção & controle , Traumatismos do Pé/cirurgia , Humanos , Masculino
14.
Int Wound J ; 16(5): 1222-1229, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31475474

RESUMO

Managing acute wounds with soft tissue loss can be very challenging for both patients and physicians. Successful wound healing depends on several factors including exudate control, prevention of infection, and moisture balance. In this case series, we describe a novel combination treatment method utilising small intestinal submucosa wound matrix (SISWM) with the bolster technique as a way of assisting the integration of collagen-based wound treatment products into the base of complex wounds with the intent of restoring a dysfunctional extracellular matrix. In case 1, a 44-year-old female presented with an acute wound resulting from a spider bite to the posterior aspect of the right knee. In case 2, a 12-year-old male sustained multiple injuries to his right foot from an all-terrain vehicle accident. In case 3, an 80-year-old female on anticoagulants sustained an avulsion injury to her left lower leg. In case 4, a 41-year-old female sustained a severe complex avulsion injury to the dorsal left forearm sustained from a dog bite. All patients were successfully treated with SISWM and the bolster technique, and their wounds healed completely within 6 weeks. The bolster technique, when combined with an SISWM, is a novel method designed to enable the SISWM to impart its wound healing properties to these complex traumatic wounds. This case series presents treating clinicians with a different treatment methodology to assist the patient in achieving a successful outcome.


Assuntos
Matriz Extracelular/transplante , Mucosa Intestinal/transplante , Traumatismos da Perna/terapia , Lesões dos Tecidos Moles/cirurgia , Picaduras de Aranhas/complicações , Cicatrização/fisiologia , Acidentes de Trânsito , Adulto , Idoso de 80 Anos ou mais , Criança , Desbridamento/métodos , Feminino , Seguimentos , Traumatismos do Pé/diagnóstico , Traumatismos do Pé/cirurgia , Humanos , Traumatismos do Joelho/diagnóstico , Traumatismos do Joelho/cirurgia , Traumatismos da Perna/diagnóstico , Masculino , Medição de Risco , Amostragem , Lesões dos Tecidos Moles/diagnóstico , Fatores de Tempo
15.
Clin Podiatr Med Surg ; 36(4): 553-562, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31466567

RESUMO

Flexible fixation has been described and utilized in various aspects of foot and ankle surgery over the past several decades. In regards to ankle surgery, flexible fixation devices have been used for stabilization of the ankle syndesmosis and augmentation of lateral collateral ankle ligament repair. In the foot, flexible fixation devices have been incorporated into hallux valgus or varus correction, Lisfranc injury repair, and more recently spring ligament repair augmentation. This article reviews the various applications for flexible fixation in foot and ankle surgery, as well as evidence-based literature on surgical applications and clinical outcomes.


Assuntos
Fraturas do Tornozelo/cirurgia , Traumatismos do Tornozelo/cirurgia , Traumatismos do Pé/cirurgia , Fixadores Internos , Ligamentos Articulares/lesões , Ligamentos Articulares/cirurgia , Suturas , Humanos
16.
Acta Orthop Belg ; 85(2): 150-158, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31315005

RESUMO

A Lisfranc injury is when one or more of the metatarsals are displaced from the tarsus. The term is more commonly used to describe an injury to the midfoot, centred on the 2nd tarso-metatarsal joint. These fractures are sometimes easily overlooked, especially if they are part of a polytrauma. They are often difficult to diagnose and treat, but if they go undetected and are not properly treated, they can cause long-term or chronic disability. Our team reviewed a group of 71 patients with a Lisfranc fracture dislocation. The lesions were classified according to Meyerson classification. All the patients were re-evaluated 3 years after their surgeries by clinical examination, Ankle-Hindfoot Scale AOFAS questionnaire, X-rays and baropodometric analysis. This review outlines the treatment outcome of this injury, taking into consideration the timing of diagnosis.


Assuntos
Traumatismos do Pé/cirurgia , Fraturas Ósseas/cirurgia , Luxações Articulares/cirurgia , Ossos do Metatarso/lesões , Ossos do Tarso/lesões , Articulações Tarsianas/cirurgia , Adulto , Idoso , Feminino , Traumatismos do Pé/diagnóstico por imagem , Fixação de Fratura , Fraturas Ósseas/diagnóstico por imagem , Humanos , Luxações Articulares/diagnóstico por imagem , Masculino , Ossos do Metatarso/diagnóstico por imagem , Ossos do Metatarso/cirurgia , Pessoa de Meia-Idade , Radiografia , Estudos Retrospectivos , Ossos do Tarso/diagnóstico por imagem , Ossos do Tarso/cirurgia , Articulações Tarsianas/diagnóstico por imagem , Resultado do Tratamento , Adulto Jovem
17.
Zhonghua Shao Shang Za Zhi ; 35(7): 495-500, 2019 Jul 20.
Artigo em Chinês | MEDLINE | ID: mdl-31357818

RESUMO

Objective: To investigate the clinical effects of extra-long lateral femoral supercharged perforator flaps in repair of ankle and foot wounds. Methods: From March 2014 to October 2018, 16 patients with foot and ankle injuries were admitted to our hospital and left large area of wounds on foot and ankle after emergency treatment. There were 13 males and 3 females, with age of 27 to 60 years. The area of the wounds ranged from 14 cm×10 cm to 40 cm×17 cm. The wounds were repaired with extra-long lateral femoral supercharged perforator flaps. The widths of flaps in 8 patients were longer than 8 cm, and the bilobed flaps were designed to repair the wounds. The area of the flaps ranged from 12 cm×5 cm to 40 cm×9 cm. During the operation, 54 perforators were detected, with an average of 3.2 perforators in each flap, and 36 source arteries of perforators were detected. The blood vessel trunk of 15 patients was descending branch of the lateral femoral circumflex artery, and their supercharged mode was anastomosis of the bulky perforator of descending branch of the lateral femoral circumflex artery with the oblique branch of the lateral femoral circumflex artery and/or medial femoral circumflex artery or the descending branch of superficial illiac circumflex artery. The blood vessel trunk of 1 patient was oblique branch of the lateral femoral circumflex artery, and the supercharged mode of the patient was anastomosis of the oblique branch of the lateral femoral circumflex artery with the bulky perforator of the descending branch of the lateral femoral circumflex artery. The wounds were covered with the flaps after supercharged blood vessel anastomosis, and blood vessels in the donor sites were anastomosed with those in the recipient sites. The donor site was sutured directly. The survival of the flap after the operation and healing time of the wound, and the flap condition, the two-point discrimination distance of flap in patients who were reconstructed with sensation, the recovery of the ankle function, and the appearance of the donor site during follow-up were recorded. Results: A total of 17 flaps in 16 patients were designed, including 8 bilobed flaps and 9 non-lobulated flaps. Sixteen flaps in 15 patients survived. Vascular crisis occurred in the flap of one patient, and the flap survived when the vascular crisis was relieved by the second operation. The healing time of foot and ankle wounds ranged from 12 to 90 days. All the lateral femoral donor sites healed completely. During follow-up of 8 to 48 months, flaps in 2 patients were slightly bloated and were trimmed in 6 months after the operation. The other flaps were with good appearance, soft texture, good elasticity, and no rupture or ulceration. The two-point discrimination distances of flaps ranged from 7 to 16 mm in 8 patients who were reconstructed with sensation, and the other flaps recovered protective sensation. The flexion and extension function of ankle joint recovered well, and the walking function was not affected significantly. All donor sites formed linear scar, with no deep tissue infection such as osteomyelitis. Conclusions: The application of extra-long lateral femoral supercharged perforator flaps to repair the large area of wounds in foot and ankle can significantly reduce damage to donor sites and has advantages of rich blood supply and good safety, thus it has satisfactory clinical effects.


Assuntos
Traumatismos do Tornozelo/cirurgia , Traumatismos do Pé/cirurgia , Retalho Perfurante/transplante , Procedimentos Cirúrgicos Reconstrutivos , Lesões dos Tecidos Moles/cirurgia , Adulto , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Transplante de Pele
18.
Injury ; 50(8): 1489-1494, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31300162

RESUMO

BACKGROUNDS: Due to the delicate tissue, small blood vessels and incomplete development of interarticular ligaments, skin and soft-tissue defects of the foot and ankle in pediatric patients remain a challenge for orthopedic and plastic surgeons. Anterolateral thigh perforator (ALTP) flap and deep inferior epigastric perforator (DIEP) flap are the most commonly used flaps for the repair of lower-extremity soft-tissue defects. The literature contains a shortage of evidence involving the differences between ALTP and DIEP flaps in the reconstruction of young patients with complex foot and ankle defects. This study was designed to determine which type of flap is better for foot and ankle repair in pediatric patients. METHODS: From January 2004 to January 2018, 79 children younger than 14 years treated with DIEP flap (41 cases) or ALTP flap (38 cases) for composite defects of the feet and ankles were retrospectively investigated. The two groups were homogeneous in terms of age, the location of the defect, etiology, and flap area. Complications, scarring, cosmetic appearance, flap sensory recovery, and functional outcome were analyzed, and statistical analysis was performed. RESULTS: The ALTP group had shorter operation time (155.0 ±â€¯12.0 min vs 212.2 ±â€¯23.9 min), flap harvested time (39.6 ±â€¯5.1 min vs 57.2 ±â€¯10.4 min), and operative blood loss (143.4 ±â€¯23.7 ml vs 170.7 ±â€¯44.7 ml) than the DIEP group (P <  0.05). In short-term follow-up, ALTP group showed a lower flap necrosis rate (5.3% vs 24.4%) and vascular insufficiency rate (2.6% vs 19.5%) than DIEP group (P <  0.05). In long-term follow-up, ALTP group showed a lower late complication rate and better cosmetic, functional, scar outcomes than DIEP group (P <  0.05). CONCLUSIONS: The study showed that an ALTP flap may brings better results than a DIEP flap in terms of short- and long-term complications, scarring, and morpho-functional outcomes for pediatric patients undergoing reconstruction of foot and ankle defects.


Assuntos
Traumatismos do Tornozelo/cirurgia , Traumatismos do Pé/cirurgia , Sobrevivência de Enxerto/fisiologia , Retalho Perfurante/irrigação sanguínea , Procedimentos Cirúrgicos Reconstrutivos , Lesões dos Tecidos Moles/cirurgia , Traumatismos do Tornozelo/fisiopatologia , Pré-Escolar , Desbridamento , Feminino , Traumatismos do Pé/fisiopatologia , Humanos , Masculino , Procedimentos Cirúrgicos Reconstrutivos/métodos , Estudos Retrospectivos , Transplante de Pele/métodos , Lesões dos Tecidos Moles/fisiopatologia , Coxa da Perna/cirurgia , Resultado do Tratamento , Cicatrização/fisiologia
19.
J Coll Physicians Surg Pak ; 29(7): 685-687, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31253227

RESUMO

Treating mid- and forefoot wounds is challenging. We share our clinical experience and describe the treatment of foreand midfoot wounds by grafting pedicled distal peroneal artery perforator (PNAP) flaps. The study enrolled 21 patients with fore- and midfoot injuries, who underwent grafting with a pedicled distal PNAP flap between August 2013 and May 2016. All of the flaps survived and were followed for 2 to 11 months. The appearance and texture of these flaps were good. The range of motion of the injured ankle was similar to the unaffected side. There were no complications, such as scar contracture, ulcer, or tenderness. The pedicled distal PNAP flaps can effectively extend the length of the flap pedicles and are better for repairing fore- and midfoot wounds than the traditional distally pedicled sural neuro-fasciocutaneous flaps.


Assuntos
Traumatismos do Pé/cirurgia , Retalho Perfurante , Procedimentos Cirúrgicos Reconstrutivos , Adolescente , Adulto , Estudos de Coortes , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Resultado do Tratamento , Adulto Jovem
20.
Injury ; 50(8): 1483-1488, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31213306

RESUMO

AIMS: Fractures and dislocations of the midfoot are relatively uncommon but can be life changing injuries. Within the literature, there has been scant specific reference to the identification and management of medial ray injuries in midfoot trauma. Moreover, it is appreciated that these injuries are associated with poor outcomes. We aim to clearly define these injury characteristics and demonstrate fixation techniques. PATIENTS AND METHODS: A retrospective review of the case notes and imaging was conducted for operatively treated midfoot injuries between January 2013 and January 2018. RESULTS: 161 patients were identified, 31 of these with imaging and operative diagnosis suggestive of medial ray injury. Studying these 31 injuries revealed five patterns of injury. CONCLUSION: When treating midfoot trauma, it is important to fully understand the injury pattern as this dictates the principles and techniques of fixation. Identification and knowledge of these five injury patterns will aid surgeons in future management of these injuries and may improve treatment outcomes.


Assuntos
Traumatismos do Pé/classificação , Fixação Interna de Fraturas/métodos , Fraturas Ósseas/classificação , Luxações Articulares/classificação , Adolescente , Adulto , Idoso , Fenômenos Biomecânicos , Feminino , Traumatismos do Pé/diagnóstico por imagem , Traumatismos do Pé/fisiopatologia , Traumatismos do Pé/cirurgia , Fraturas Ósseas/diagnóstico por imagem , Fraturas Ósseas/fisiopatologia , Fraturas Ósseas/cirurgia , Humanos , Luxações Articulares/diagnóstico por imagem , Luxações Articulares/fisiopatologia , Luxações Articulares/cirurgia , Masculino , Pessoa de Meia-Idade , Procedimentos Ortopédicos , Radiografia , Estudos Retrospectivos , Resultado do Tratamento , Adulto Jovem
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