The clinical outcomes of scaphoid nonunion treated with a precisely processed autologous bone screw: a case series

Punch grafting is an alternative treatment to enhance wound healing which has been associated with promising clinical outcomes in various leg and foot wound types. We aimed to evaluate the clinical outcomes of punch grafting as a treatment for hard-to-heal diabetic foot ulcers (DFUs). Six patients with chronic neuropathic or neuroischemic DFUs with more than 6 months of evolution not responding to conventional treatment were included in a prospective case series between May 2017 and December 2020. All patients were previously debrided using an ultrasound-assisted wound debridement and then, grafted with 4 to 6 mm punch from the donor site that was in all cases the anterolateral aspect of the thigh. All patients were followed up weekly until wound healing. Four (66.7%) DFUs were located in the heel, 1 (16.7%) in the dorsal aspect of the foot and 1 (16.7%) in the Achilles tendon. The median evolution time was 172 (interquartile range [IQR], 25th-75th; 44-276) weeks with a median area of 5.9 (IQR; 1.87-37.12) cm2 before grafting. Complete epithelization was achieved in 3 (50%) patients at 12 weeks follow-up period with a mean time of 5.67 ± 2.88 weeks. Two of the remaining patients achieved wound healing at 32 and 24 weeks, respectively, and 1 patient showed punch graft unsuccessful in adhering. The median time of wound healing of all patients included in the study was 9.00 (IQR; 4.00-28.00) weeks. The wound area reduction (WAR) at 4 weeks was 38.66% and WAR at 12 weeks was 88.56%. No adverse effects related to the ulcer were registered through the follow-up period. Autologous punch graft is an easy procedure that promotes healing, achieving wound closure in chronic DFUs representing an alternative of treatment for hard-to-heal DFUs in which conservative treatment has been unsuccessful.

Download Full-text

Combining Microfractures, Autologous Bone Graft, and Autologous Matrix-Induced Chondrogenesis for the Treatment of Juvenile Osteochondral Talar Lesions

Foot & Ankle International ◽

10.1177/1071100716687367 ◽

2017 ◽

Vol 38 (5) ◽

pp. 485-495 ◽

Cited By ~ 17

Author(s):

Riccardo D’Ambrosi ◽

Camilla Maccario ◽

Chiara Ursino ◽

Nicola Serra ◽

Federico Giuseppe Usuelli

Keyword(s):

Bone Graft ◽

Repeated Measures ◽

Osteochondral Lesion ◽

Young Patients ◽

Case Series ◽

Autologous Bone Graft ◽

Lesion Size ◽

Level Of Evidence ◽

Significant Difference ◽

Autologous Bone

Background: The purpose of this study was to evaluate the clinical and radiologic outcomes of patients younger than 20 years, treated with the arthroscopic-talus autologous matrix-induced chondrogenesis (AT-AMIC) technique and autologous bone graft for osteochondral lesion of the talus (OLT). Methods: Eleven patients under 20 years (range 13.3-20.0) underwent the AT-AMIC procedure and autologous bone graft for OLTs. Patients were evaluated preoperatively (T0) and at 6 (T1), 12 (T2), and 24 (T3) months postoperatively, using the American Orthopaedic Foot & Ankle Society Ankle and Hindfoot (AOFAS) score, the visual analog scale and the SF-12 respectively in its Mental and Physical Component Scores. Radiologic assessment included computed tomographic (CT) scan, magnetic resonance imaging (MRI) and intraoperative measurement of the lesion. A multivariate statistical analysis was performed. Results: Mean lesion size measured during surgery was 1.1 cm3 ± 0.5 cm3. We found a significant difference in clinical and radiologic parameters with analysis of variance for repeated measures ( P < .001). All clinical scores significantly improved ( P < .05) from T0 to T3. Lesion area significantly reduced from 119.1 ± 29.1 mm2 preoperatively to 77.9 ± 15.8 mm2 ( P < .05) at final follow-up as assessed by CT, and from 132.2 ± 31.3 mm2 to 85.3 ± 14.5 mm2 ( P < .05) as assessed by MRI. Moreover, we noted an important correlation between intraoperative size of the lesion and body mass index (BMI) ( P = .011). Conclusions: The technique can be considered safe and effective with early good results in young patients. Moreover, we demonstrated a significant correlation between BMI and lesion size and a significant impact of OLTs on quality of life. Level of Evidence: Level IV, retrospective case series.

Download Full-text

The application of an allogeneic bone screw for osteosynthesis in hand and foot surgery: a case series

Archives of Orthopaedic and Trauma Surgery ◽

10.1007/s00402-021-03880-6 ◽

2021 ◽

Author(s):

Klaus Pastl ◽

Wolfgang Schimetta

Keyword(s):

Healing Process ◽

Case Series ◽

Clinical Importance ◽

Fusion Rate ◽

Surrounding Tissue ◽

Allogeneic Bone ◽

Foot Surgery ◽

Bone Screw ◽

Transplant Failure

Abstract Introduction The allogeneic bone screw transplant is a new osteosynthesis device making the use of foreign fixation material obsolete for various kinds of indications. Moreover, it is integrated into the recipient bone by natural bone remodeling without harming the surrounding tissue. The aim of this study was to determine the efficacy and safety of the transplant for osteotomy and arthrodesis in hand and foot surgery and to evaluate the clinical importance of the device. Materials and methods A single-surgeon case series of 32 patients who had undergone hand or foot surgery with the application of an allogeneic bone screw with an average follow-up time of 1 year is reported. Clinical data were reviewed to evaluate the pain levels and satisfaction of the patients and the frequency and type of complications occurring during the healing process. Routine radiography and computed tomography were reviewed to determine the fusion rate, the ingrowth behavior of the transplant and the possible occurrence of transplant failure. Results High patient satisfaction was paired with low postoperative pain levels and a low complication rate. 97% of the patients were free of pain at the timepoint of the second follow-up examination, the mean time of recovery of full mobility was 50.1 ± 26.1 days after surgery. Wound healing disturbance occurred only in two cases. Bony consolidation of the osteotomy or arthrodesis gap as well as osseointegration of the transplant was seen in all cases. No transplant failure or transplant loosening occurred. Conclusions The application of the allogeneic bone screw resulted in a 100% fusion rate while the patient burden was low. The transplant is safe and suited for various kinds of osteosynthesis in hand and foot surgery.

Download Full-text

Clinical outcomes of the piggyback secondary implantation of a novel multifocal lens in the ciliary sulcus: A case series

European Journal of Ophthalmology ◽

10.1177/11206721211029474 ◽

2021 ◽

pp. 112067212110294

Author(s):

Gerardo Valvecchia ◽

Guadalupe Cervantes-Coste ◽

Oscar Asis ◽

Federico Pereyra ◽

Manuel Garza-León ◽

...

Keyword(s):

Clinical Outcomes ◽

Case Series ◽

Visual Outcome ◽

Iol Implantation ◽

Secondary Implantation ◽

Intermediate Distance ◽

Efficient Alternative ◽

Monofocal Iol ◽

Multifocal Lens ◽

Prospective Case Series

Purpose: Evaluate the clinical outcomes of the secondary piggyback add-on IOL implantation in the ciliary sulcus for pseudophakic patients previously implanted with a monofocal IOL, who pursue a spectacle-free option after IOL surgery. Methods: A prospective case series including seven pseudophakic patients who underwent an in-the-bag monofocal IOL implantation. All eyes underwent a piggyback IOL implantation of the new sulcus designed A4 AddOn IOL in the ciliary sulcus as a secondary procedure for pseudophakic patients pursuing a spectacle-free option for near and intermediate distance after IOL surgery. Results: Seven eyes from six patients were included in this study, from which 4 (71.43%) were female, with a mean age of 58.33 ± 3.5 years (range 54–63; 95% CI 54.66, 62.01). The postoperative spherical equivalent at the 3-month visit was −0.10 m ± 0.82. Also, the UDVA was 0.11 ± 0.08 logMAR, the UIVA 0.01 ± 0.03, and the UNVA 0.01 ± 0.03 3 months after their surgical procedure. Conclusions: The A4 AddOn multifocal IOL’s secondary piggyback implant is an efficient alternative for monofocal pseudophakic patients seeking presbyopia solutions. This sulcus-designed IOL provides an optimal visual outcome for near and distance vision.

Download Full-text

Impact of Pathological Stratification on the Clinical Outcomes of Advanced Well-Differentiated/Dedifferentiated Liposarcoma Treated with Trabectedin

Cancers ◽

10.3390/cancers13061453 ◽

2021 ◽

Vol 13 (6) ◽

pp. 1453

Author(s):

Chiara Fabbroni ◽

Giovanni Fucà ◽

Francesca Ligorio ◽

Elena Fumagalli ◽

Marta Barisella ◽

...

Keyword(s):

Clinical Outcomes ◽

Proportional Hazards ◽

Case Series ◽

Progression Free Survival ◽

Cox Proportional Hazards ◽

Low Grade ◽

High Grade ◽

Retrospective Case ◽

Well Differentiated ◽

The Impact

Background. We previously showed that grading can prognosticate the outcome of retroperitoneal liposarcoma (LPS). In the present study, we aimed to explore the impact of pathological stratification using grading on the clinical outcomes of patients with advanced well-differentiated LPS (WDLPS) and dedifferentiated LPS (DDLPS) treated with trabectedin. Patients: We included patients with advanced WDLPS and DDLPS treated with trabectedin at the Fondazione IRCCS Istituto Nazionale dei Tumori between April 2003 and November 2019. Tumors were categorized in WDLPS, low-grade DDLPS, and high-grade DDLPS according to the 2020 WHO classification. Patients were divided in two cohorts: Low-grade (WDLPS/low-grade DDLPS) and high-grade (high-grade DDLPS). Results: A total of 49 patients were included: 17 (35%) in the low-grade cohort and 32 (65%) in the high-grade cohort. Response rate was 47% in the low-grade cohort versus 9.4% in the high-grade cohort (logistic regression p = 0.006). Median progression-free survival (PFS) was 13.7 months in the low-grade cohort and 3.2 months in the high-grade cohort. Grading was confirmed as an independent predictor of PFS in the Cox proportional-hazards regression multivariable model (adjusted hazard ratio low-grade vs. high-grade: 0.45, 95% confidence interval: 0.22–0.94; adjusted p = 0.035). Conclusions: In this retrospective case series, sensitivity to trabectedin was higher in WDLPS/low-grade DDLPS than in high-grade DDLPS. If confirmed in larger series, grading could represent an effective tool to personalize the treatment with trabectedin in patients with advanced LPS.

Download Full-text

Clinical outcomes and kinetics of propanil following acute self-poisoning: a prospective case series

BMC Clinical Pharmacology ◽

10.1186/1472-6904-9-3 ◽

2009 ◽

Vol 9 (1) ◽

Cited By ~ 25

Author(s):

Darren M Roberts ◽

Renate Heilmair ◽

Nick A Buckley ◽

Andrew H Dawson ◽

Mohamed Fahim ◽

...

Keyword(s):

Clinical Outcomes ◽

Case Series ◽

Prospective Case Series ◽

Kinetics Of

Download Full-text

Rapid Pore Cranial Drilling With External Ventricular Drainage for Treatment of Intraventricular Hemorrhage: A 36-Year Case Series

International Surgery ◽

10.9738/intsurg-d-14-00222.1 ◽

2015 ◽

Vol 100 (6) ◽

pp. 1117-1123 ◽

Cited By ~ 1

Author(s):

Wei Zhang ◽

Lin Wei ◽

Gang Li ◽

Jinlong Sun ◽

Peng Jin ◽

...

Keyword(s):

Clinical Outcomes ◽

Intraventricular Hemorrhage ◽

Blood Clot ◽

Controlled Trial ◽

Case Series ◽

External Ventricular Drainage ◽

Therapeutic Effects ◽

Ventricular Drainage ◽

Drilling Technique ◽

Conventional Drilling

This study aimed to describe the technique details of rapid pore cranial drilling with external ventricular drainage and document its clinical outcomes by highlighting the advantages over the traditional and modified cranial drilling technique. Intraventricular hemorrhage is one of the most severe subtypes of hemorrhagic stroke with high mortality. The amount of blood in the ventricles is associated with severity of outcomes, and fast removal of the blood clot is the key to a good prognosis. Between 1977 and 2013, 3773 patients admitted for intraventricular hemorrhage underwent rapid pore cranial drilling drainage. The therapeutic effects and clinical outcomes were retrospectively analyzed. Of these patients, 1049 (27.8%) experienced complete remission, 1788 (47.4%) had improved condition, and 936 (24.8%) died. A total of 3229 (85.6%) patients gained immediate remission. One typical case was illustrated to demonstrate the efficacy of the rapid pore drilling technique. Rapid pore cranial drilling drainage in patients with intraventricular hemorrhage is fast, effective, and provides immediate relief in patients with severe conditions. It could be a better alternative to the conventional drilling approach for treatment of intraventricular hemorrhage. A randomized controlled trial for direct comparison between the rapid pore cranial drilling drainage and conventional drilling technique is in urgent need.

Download Full-text

Deformity and Clinical Outcomes Following Operative Correction of Charcot Ankle

Foot & Ankle International ◽

10.1177/1071100718805076 ◽

2018 ◽

Vol 40 (2) ◽

pp. 145-151 ◽

Cited By ~ 5

Author(s):

Elizabeth A. Harkin ◽

Andrew M. Schneider ◽

Michael Murphy ◽

Adam P. Schiff ◽

Michael S. Pinzur

Keyword(s):

Clinical Outcome ◽

Clinical Outcomes ◽

Ankle Joint ◽

Chronic Wounds ◽

Surgical Techniques ◽

Case Series ◽

Lessons Learned ◽

Charcot Foot ◽

Operative Correction ◽

Therapeutic Footwear

Background: Deformity associated with Charcot foot arthropathy leads to a poor quality of life in affected individuals. Deformity in the midfoot appears to be predictive of clinical outcomes following operative correction. The goal of this retrospective study was to determine if that same methodology could be applied to patients treated for Charcot foot arthropathy involving the ankle joint. Methods: Fifty-six consecutive patients underwent operative reconstruction of Charcot foot deformity involving the ankle joint by a single surgeon over a 14-year period. Preoperative patient characteristics and tibiotalar alignment, were recorded. Surgical treatment included single-stage debridement of active infection and ankle arthrodesis with application of a circular external fixator when infection was present (39 of 56, 69.6%) or retrograde locked intramedullary nailing in the absence of infection (17 of 56, 30.3%). Clinical outcomes were graded based on limb salvage, resolution of infection and chronic wounds, and the ability to ambulate with therapeutic footwear or accommodative orthoses. The average follow-up was 7.5 (range 1.1-14.0) years. Results: One patient died at 134.3 weeks following surgery of unrelated causes and 8 underwent amputation. Twenty-eight of 56 patients (50.0%) achieved a favorable (excellent or good) clinical outcome. There was no significant association between pre- or postoperative alignment and clinical outcomes. Insulin-dependent diabetics were approximately 3 times more likely to have a poor clinical outcome. Conclusions: Operative correction of Charcot deformity involving the ankle joint was associated with a high complication rate and risk for failure. The lessons learned from this highly comorbid patient population with complex deformities can be used as a benchmark for applying modern surgical techniques. Level of Evidence: Level IV, case series.

Download Full-text