Stepwise surgical technique used to treat recalcitrant pretibial ulcerations: a case series.

INTRODUCTION: Pretibial lacerations resulting from trauma may evolve into chronic wounds with worsening infections without treatment. There is a limited amount of literature on the presentation and treatment of recalcitrant pretibial ulcerations. OBJECTIVE: This study aims to provide a review of surgical treatment methodology that successfully managed recalcitrant pretibial ulcerations. MATERIALS AND METHODS: The authors conducted a retrospective case review of patients with pretibial ulcerations. All wounds underwent aggressive debridement in the operative setting. Next, the wounds were fenestrated with a needle before placing one application of an antimicrobial acellular dermal tissue matrix derived from fetal bovine dermis, which was tightly adhered onto the wound bed. All wounds received a uniform multilayer compression dressing. RESULTS: Three patients with pretibial ulcerations were included in this study. Each wound was a result of mechanical trauma and deteriorated into a refractory ulceration despite initial conservative treatment for more than 6 months. All ulcers exhibited local infection of cellulitis, hematoma, and a collection of purulent fluid. None of the wounds had any signs of radiographic osteomyelitis. The application of the allograft following debridement and fenestration led to wound volume reduction by 75%, 66.7%, and 50% in 3 patients in 28 days. All wounds healed successfully within 4 months. CONCLUSIONS: The combination of a fenestration method and an antimicrobial fetal bovine dermal matrix successfully healed recalcitrant pretibial ulcerations in high-risk patients.

Endoscopic calcaneoplasty with gastrocnemius recession for Haglund's syndrome: Is it safe and effective? Results from a retrospective case series.

BACKGROUND: Endoscopic calcaneoplasty (ECP) and gastrocnemius recession (GR) are procedures that have been described to effectively treat Haglund's deformity and insertional Achilles tendinopathy respectively. The purpose of our manuscript is to evaluate the efficacy and safety of ECP and GR with immediate weightbearing for the treatment of Haglund's deformity with mild to moderate insertional Achilles tendinopathy. METHODS: We performed ECP coupled with GR on 14 patients with an average age of 52 years. All patients demonstrated < 50% tendinous degeneration on MRI. All were allowed weightbearing as tolerated in a CAM boot within the first post-operative week. AOFAS scores and plain film radiographic findings were collected pre-operatively and post-operatively. RESULTS: The radiographic exam of the Fowler-Philip angle significantly improved from an average 60.1-40.7° (p < 0.001). The AOFAS ankle/hindfoot score significantly improved from an average 54.7-91.4 (p < 0.001). The average return to work was 7.5 weeks. There were two cases of temporary sural nerve paresthesia, and two cases of delayed wound healing. CONCLUSIONS: This is the first mid-term study evaluating the outcomes of ECP with GR. The results of our study suggest that ECP with GR followed by immediate weightbearing is a safe and effective procedure for the treatment of Haglund's deformity and mild to moderate insertional Achilles tendinopathy.