Soft Tissue Coverage After Revisional Foot and Ankle Surgery

2017 ◽  
Vol 34 (3) ◽  
pp. 389-398
Author(s):  
Geoffrey G. Hallock
Keyword(s):  
Soft Tissue ◽  
Soft Tissue Coverage ◽  
Foot And Ankle ◽  
Ankle Surgery

scholarly journals The Jones Dressing Cast for Safe Aftercare of Foot and Ankle Surgery: A Modification of the Jones Dressing Bandage

2020 ◽  
Vol 5 (4) ◽  
pp. 2473011420S0023
Author(s):  
Tonio Gottlieb ◽  
Kaj Klaue
Keyword(s):  
Soft Tissue ◽  
Soft Tissues ◽  
Complication Rates ◽  
Foot And Ankle ◽  
Soft Tissue Healing ◽  
Reconstructive Procedures ◽  
Tissue Healing ◽  
Ankle Surgery ◽  
Autonomous Mobility ◽  
Group 2

Category: Ankle; Basic Sciences/Biologics; Hindfoot; Midfoot/Forefoot; Trauma; Other Introduction/Purpose: The management of postoperative soft tissue healing is fundamental for the success of elective foot and ankle surgery. As postoperative edema is more relevant in such surgery due to its localization, soft tissue healing can take longer and pain can restrict function. There is no universal approach to surgery aftercare among foot and ankle surgeons. Although infections following foot and ankle surgery are rare, soft tissue healing can be jeopardized after extensive and multiple approaches. Postoperative edema, however, is common and contributes to unfavorable conditions for wound healing. Our study addresses the results of avoiding postoperative edema with the use of the Jones dressing cast. Methods: We defined a precise fixation technique of the foot and ankle in the immediate post-operative phase using what we call ‘the Jones dressing cast’. This technique is a modification of the Jones dressing bandage. In a previous study we compared two groups of patients (N = 20/23) who underwent similar reconstructive surgery with the application of the described cast for one week and without. At the twomonth follow-up we observed that the group treated with the cast required less pain relief, spent less time in hospital and achieved faster autonomy using crutches (Gottlieb and Klaue, 2013). In this study we considered a group of 45 patients who underwent similar reconstructive procedures to those in the first study and who were treated with the cast for two weeks post-operatively. There was no visual check of the soft tissues before removal of the cast. Results: Although patients in Group 2 had more complex surgery, mobility was achieved earlier and hospitalization time was shorter. The incidence of infection was lower in the group wearing the cast for 2 weeks. The patients treated with the cast for 2 weeks regained autonomous mobility significantly earlier than those in Group 1 (cast 1 week or less). Conclusion: The Jones dressing cast is a useful tool that can help minimize postoperative complication rates. Wearing the cast for two weeks is preferable. Our study suggests its effectiveness in reducing soft tissue complications and facilitating independent mobility.

Soft tissue anchor systems

1994 ◽  
Vol 84 (4) ◽  
pp. 157-170 ◽  
Author(s):  
GV Yu ◽  
T Chang ◽  
JM White
Keyword(s):  
Soft Tissue ◽  
Surgical Techniques ◽  
Foot And Ankle ◽  
Comprehensive Overview ◽  
Advantages And Disadvantages ◽  
Ankle Surgery ◽  
Soft Tissue Attachment ◽  
Anchor Systems ◽  
Tissue Attachment

The concept of soft tissue attachment and reattachment has been addressed over the years through a variety of surgical techniques. This includes tendons and ligaments that have been detached both surgically and traumatically from their osseous origins or insertions. This study is designed to provide the reader with a comprehensive overview of current commercially available devices. Detailed descriptions of the various devices are provided along with a discussion of the advantages and disadvantages of each. Their application and use in reconstructive foot and ankle surgery are also discussed.

scholarly journals Opioid Consumption Rate After Foot and Ankle Surgery

2019 ◽  
Vol 4 (2) ◽  
pp. 2473011419S0000
Author(s):  
Peter Kvarda ◽  
Noortje Hagemeijer ◽  
Gregory R. Waryasz ◽  
Daniel Guss ◽  
Christopher W. DiGiovanni ◽  
...  
Keyword(s):  
Risk Factors ◽  
Postoperative Pain ◽  
Soft Tissue ◽  
Consumption Rate ◽  
Opioid Consumption ◽  
Foot And Ankle ◽  
Soft Tissue Procedure ◽  
Ankle Surgery ◽  
Ed Visits ◽  
Telephone Calls

Category: Opioid consumption rate and risk factors investigation after foot and ankle surgery Introduction/Purpose: The rapid increase in the consumption of prescription opioids has become one of the leading medical, economical, and sociological burdens in North America. In the United States, orthopedic surgery is the fourth leading specialty in the number of opioids prescribed, and the largest among surgical specialties. There is insufficient evidence to guide surgeons about appropriate opioid prescription amounts after orthopaedic foot and ankle (F&A) procedures. The aim of this study was to determine the opioid consumption rate after foot and ankle procedures, and to identify patient risk factors associated with higher use. Methods: A total of 535 patients who underwent a F&A surgery performed by one orthopedic surgeon from August 2016 to March 2018 were investigated. The study was approved by our IRB. Each patient received a preoperative discussion about postoperative pain and expectations alongside a standardized handout. At the two-week postoperative visit, the patient-reported amount of consumed opioids was recorded. Prescription details, the amount of opioids taken, refill requests, pain-issue related telephone calls, and additional MD/ED visits were also documented. Patient demographics and co-morbidities, use of regional anesthesia, postoperative inpatient hospitalization, surgery type and severity, and pre-operative opioid use were collected retrospectively. Total amounts of morphine equivalents were calculated and converted into oxycodone 5 mg pills for standardization. P-values of <0.05 were considered significant. Results: Two hundred forty-four patients with a mean age of 50 years (±16.3) and a BMI of 29 (±6.1) were included. Sixty-six (27%) patients underwent a soft tissue procedure alone and 178 (73%) underwent a bony procedure. 225 (92.2%) patients received regional block. Patients reported that they consumed only 51.2% of prescribed pills after a bony procedure and 42.4% after a soft tissue procedure, respectively, which resulted in a total of 4,496.2 left over pills that derived from this study amongst only 244 patients enrolled. There were 11 refill requests (4.5%), two (0.8%) additional MD/ED visits, and 19 (7.8%) telephone calls related to pain. BMI, procedure type, and number of opioids prescribed were positively correlated with the consumption rate (P =.002, P<.001, P<0.001, respectively). Conclusion: BMI, surgery type (bony vs. soft tissue), and a higher number of pills dispensed were correlated with higher use in the postoperative period. After an educative discussion on postoperative pain, patients took 42.4% of the prescribed opioid after soft tissue procedures and 51.2% after bony procedures, resulting in a significant number of unused pills now available to the community. Future guidelines are necessary to improve our postoperative pain management, but this study suggests that current amounts of dispensed pills after orthopaedic F&A procedures are approximately twice as high as necessary.

The Role of Plastic Surgery for Soft Tissue Coverage of the Diabetic Foot and Ankle

2014 ◽  
Vol 31 (1) ◽  
pp. 127-150 ◽  
Author(s):  
Peter A. Blume ◽  
Ryan Donegan ◽  
Brian M. Schmidt
Keyword(s):  
Soft Tissue ◽  
Plastic Surgery ◽  
Diabetic Foot ◽  
Soft Tissue Coverage ◽  
Foot And Ankle

scholarly journals Opioid Consumption and Time to Return to Work After Percutaneous Foot and Ankle Surgery

2019 ◽  
Vol 4 (4) ◽  
pp. 2473011419S0001
Author(s):  
Jimmy J. Chan ◽  
Javier Z. Guzman ◽  
Kevin K. Chen ◽  
Jesse C. Chan ◽  
Ettore Vulcano
Keyword(s):  
Soft Tissue ◽  
Return To Work ◽  
Opioid Consumption ◽  
Foot And Ankle ◽  
Foot Surgery ◽  
Average Return ◽  
Forefoot Surgery ◽  
Ankle Surgery ◽  
The Usa ◽  
Long Acting

Category: Hindfoot, Lesser Toes, Midfoot/Forefoot Introduction/Purpose: Orthopaedic surgeons are the 5th highest prescriber for narcotics in the USA. Foot and ankle procedures can be amongst some of the more painful procedures in orthopedics. A recent study demonstrated that patient underwent open foot and ankle surgeries averaged 27.2 tablets of narcotics with 37% of patients unwilling to stop at 3-month post-operative visit. Percutaneous techniques for foot and ankle procedures were recently approved in the U.S., which allow for significantly smaller incisions and minimal soft tissue disruption, which may potentially decrease post-operative pain and allow faster recovery. The purpose of this study is to assess the total opioid consumption and time for return to work following percutaneous foot and ankle surgery. Methods: In this prospective cohort study, 50 consecutive patients underwent percutaneous foot surgery (bony procedures with or without soft tissue work) by a single surgeon. All surgeries were outpatient procedures and performed under general anesthesia with a long-acting popliteal nerve block. All patients were prescribed 30 tablets of 5 mg oxycodone, 50 tablets of 500 mg acetaminophen, and 9 tablets of 600 mg ibuprofen post-operatively for pain control. All patients were given a log sheet to record number of pain medications taken during the first 14 post-operative days. The log sheet and leftover pills were collected and counted to confirm the amount of pain medication used at 2-week post-operative visit. Time return to work was also recorded in subsequent follow-up appointment. Results: All 50 patients returned their log sheet at 2-week post-operative visit. Mean age was 47.1 years. N=36 (72%) were forefoot surgeries, N=2 (4%) midfoot, N=9 (18%) hindfoot, and N=3 (6%) combined. Average oxycodone tablets taken during the first 14 days after surgery was 3.3 tablets. By the 14th day, no patient was taking any narcotic medication. The average return to work was 18.9 days post-operatively. Patients with forefoot surgery averaged 2.2 tablets of oxycodone with return to work at 10.4 days. Midfoot surgery patients averaged 3.5 tablets with return to work at 33 days. Hindfoot surgery patients averaged 5.3 tablets with return to work at 38.9 days. Combined foot surgery patients averaged 11 tablets with return to work at 54.3 days. Conclusion: This study demonstrated that percutaneous foot and ankle surgery has significant reduction and cessation in narcotic consumption post-operatively when compared to the reported values with open procedures in current literature.

scholarly journals Safety Profile of Artelon Use for Soft Tissue Reconstruction in Foot and Ankle Surgery

2020 ◽  
Vol 5 (4) ◽  
pp. 2473011420S0026
Author(s):  
Syed H. Hussaini ◽  
Daniel M. Dean ◽  
Michael Kelly ◽  
Daniel J. Cuttica
Keyword(s):  
Foreign Body ◽  
Soft Tissue ◽  
Foreign Body Reaction ◽  
Soft Tissue Reconstruction ◽  
Complication Rates ◽  
Foot And Ankle ◽  
Repeat Surgery ◽  
Ankle Surgery ◽  
Tissue Reconstruction ◽  
Vas Scores

Category: Basic Sciences/Biologics; Ankle; Hindfoot; Midfoot/Forefoot; Sports Introduction/Purpose: Artelon is a synthetic degradable polyurethaneurea graft which has been investigated and utilized for soft tissue reconstruction in a variety of orthopaedic settings. However, in the field of foot and ankle surgery, there is very limited reported clinical data on outcomes of surgery utilizing Artelon. The goal of this study was look at outcomes of foot and ankle surgery in which Artelon is used, including post-op VAS scores and complications including adverse foreign body reaction, infection, repeat surgery, and implant failure. Our hypothesis was that soft tissue reconstruction procedures utilizing artelon will have a low complication rate, similar to established complication rates for other soft tissue reconstruction procedures such as those utilizing allograft, autograft, or other synthetic tissue. Methods: The treating surgeon’s first 55 consecutive patients 18 years and older who were treated with artelon graft as part of a foot and ankle surgery are being included in this IRB-approved study. Through retrospective chart review, outcome measures including the procedure for which artelon was utilized, pre and post-op Visual Analogue Scale (VAS) scores, and complications including repeat surgery for graft failure, foreign body reaction, wound healing issues, infection, and osteolysis were assessed. Statistical analysis was done utilizing Student’s t-test for continuous variables and chi square test for categorical variables. Results: Average follow-up time was 246.5 days. The majority of patients had artelon placed for spring ligament reconstruction, brostrom procedures, or achilles tendon reconstruction. VAS scores dropped significantly from before surgery to 3 weeks post- operatively (5.6 to 3.2, p<0.05). VAS scores stabilized after 3 weeks, with final follow-up score at 2.9. There were no reports of osteolysis in the area of the graft placement, adverse foreign body reaction, or episodes of graft failure. There were two major complications involving artelon surgical sites: one patient required a free flap for wound coverage, and another required an operative debridement with hardware and artelon removal, antibiotic spacer placement, and subsequent hindfoot fusion. Other minor complications not requiring operative intervention included cellulitis (3 patients) and delayed wound healing (5). Conclusion: Artelon is a safe and effective implant that can be utilized for soft tissue reconstruction in the foot and ankle, with similar post-operative pain recovery and wound complication rates compared to established historical data for these procedures. Additional studies must be done looking at long-term patient outcomes with utilization of artelon, and direct comparative studies with other soft tissue reconstruction techniques and materials in the foot and ankle.

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