Surgical reconstruction in severe infected diabetic foot: A staged treatment algorithm

Category: Diabetes Introduction/Purpose: The total contact cast is an important component of the clinical treatment algorithm for diabetic foot ulcers and Charcot Foot Arthropathy. Few studies have reported on the complications associated with this treatment modality. Methods: Over a ten year period, 2265 total contact casts were placed on 384 patients during their treatment for diabetic foot disorders. All of the casts were applied by a Certified Orthopaedic Technologist under the supervision of a University Faculty member. Complications were grouped as: (1) development of a new ulcer or wound, (2) new or increasing odor or drainage, (3) wound infection, (4) gangrene, (5) newly identified osteomyelitis, and (6) pain or discomfort necessitating cast change / removal. Complications were then associated with Hemoglobin A1C levels at the time of treatment. Results: Using this very stringent definition of a complication, ten percent of patients had some form of a complication. Most complications resolved following cast change or cast removal. Conclusion: The total contact cast has been demonstrated to be a valuable tool in the treatment of diabetic foot disorders. This retrospective chart review should serve as a valuable reference to assist clinicians when counseling patients during treatment for diabetic foot disorders.

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Update on covered endovascular reconstruction of the aortic bifurcation

Vascular ◽

10.1177/1708538119896197 ◽

2020 ◽

Vol 28 (3) ◽

pp. 225-232

Author(s):

Michel MPJ Reijnen

Keyword(s):

Initial Data ◽

Treatment Algorithm ◽

Occlusive Disease ◽

Surgical Reconstruction ◽

Aortic Bifurcation ◽

Flow Conditions ◽

Local Flow ◽

Current Review ◽

Comparative Trials

Objective The covered endovascular reconstruction of the aortic bifurcation (CERAB) technique was introduced in 2009 in order to provide an anatomically and physiologically optimal endovascular reconstruction of the aortic bifurcation. Method In the current review, all available evidence on this technique was summarized. Results In vitro studies have shown a more favorable geometry of CERAB compared to kissing stents, leading to better local flow conditions. The results of CERAB are at least as good as those achieved with kissing stents in a more complex group of treated patients. The mid-term patency rates approach those of surgical reconstruction. Initial data show that the technique can also be used in combination with chimney grafts in order to preserve side branches. Conclusion CERAB has proven to be the most optimal endovascular treatment option for aorto-iliac occlusive disease with regard to geometry and flow and is related to promising clinical outcomes. Prospective and comparative trials are necessary to elucidate the most optimal treatment algorithm for patients with aorto-iliac occlusive disease.

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Diabetic Foot Wound Care Algorithms

Journal of the American Podiatric Medical Association ◽

10.7547/87507315-92-6-336 ◽

2002 ◽

Vol 92 (6) ◽

pp. 336-349 ◽

Cited By ~ 5

Author(s):

Paul Han ◽

Ruben Ezquerro

Keyword(s):

Diabetic Foot ◽

Wound Care ◽

Treatment Algorithm ◽

Foot Ulcers ◽

Diabetic Patients ◽

Medical Conditions ◽

Surgical Emergencies ◽

Neuropathic Foot

The purpose of this article is to present reference guidelines to assist clinicians when treating diabetic patients with foot wounds. Diabetic patients with limb-threatening foot ulcers often have multiple coexisting medical conditions that frequently become impediments to the resolution of foot wounds. Each foot wound is unique and its etiology is multifactorial; therefore, each foot wound should be managed differently. The treatment algorithm presented in this article is divided into three categories: Algorithm I describes the treatment of septic foot wounds, which may be considered true podiatric surgical emergencies; Algorithm II describes the treatment of ischemic foot ulcers or gangrene with or without underlying osteomyelitis; and Algorithm III describes the treatment of neuropathic foot ulcers with or without underlying osteomyelitis. (J Am Podiatr Med Assoc 92(6): 336-349, 2002)

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Surgical Reconstruction of the Diabetic Foot and Ankle

The Journal of Foot & Ankle Surgery ◽

10.1053/j.jfas.2009.09.001 ◽

2010 ◽

Vol 49 (1) ◽

pp. 107

Author(s):

Thomas S. Roukis

Keyword(s):

Diabetic Foot ◽

Surgical Reconstruction ◽

Foot And Ankle

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Biological Mechanisms of Chronic Wound and Diabetic Foot Healing: The Role of Collagen

Serbian Journal of Experimental and Clinical Research ◽

10.2478/sjecr-2018-0077 ◽

2018 ◽

Vol 19 (4) ◽

pp. 373-382 ◽

Cited By ~ 5

Author(s):

Victor Alexandrovich Stupin ◽

Ruslan Borisovich Gabitov ◽

Tatiana Georgievna Sinelnikova ◽

Ekaterina Vladimirovna Silina

Keyword(s):

Wound Healing ◽

Diabetic Foot ◽

World Literature ◽

Chronic Wounds ◽

Chronic Wound ◽

Treatment Algorithm ◽

Diabetic Foot Syndrome ◽

Results Of Treatment ◽

Native Collagen ◽

Chronic Ulcers

Abstract The treatment of chronic wounds is a continuously developing research focus. The problems of excessive mechanical forces, infection, inflammation, reduced production of growth factors, and lack of collagen will affect the results of treatment. The purpose of this study was to analysse the elements that lead to long-term non-healing of chronic wounds and trophic ulcers, including diabetic foot syndrome, by determining the optimal treatment algorithm. The paper presents an analysis of the world literature on the etiopathogenesis and principles of chronic wound treatment in diabetic foot syndrome. The epidemiology of chronic wounds of different genesis is presented. The issues of physiological and metabolic disorders in chronic ulcers affecting the process of wound healing are discussed. Particular attention is paid to collagen, which is a protein that forms the basis of connective tissue; collagen ensures the strength and elasticity of the skin, which confirms the importance of its role not only in aesthetics but also in the process of wound healing. Different types of collagen and their roles in the mechanisms of chronic wound healing in diabetic foot syndrome are described. The results of clinical studies evaluating the effectiveness of medical products and preparations, consisting of collagen with preserved (native collagen) and fractionated structures, in treating chronic wounds of diabetic foot syndrome are analysed. It has been shown that the use of native collagen preparations is a promising treatment for chronic ulcers and wounds, including diabetic foot syndrome, which makes it possible to increase the effectiveness of treatment and reduce the economic costs of managing these patients.

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A Staged Treatment Algorithm for the Management of Severe Charcot Hindfoot Arthropathy, using Tibiotalocalcaneal Arthrodesis with Femoral Head Allograft

Foot & Ankle Orthopaedics ◽

10.1177/2473011420s00285 ◽

2020 ◽

Vol 5 (4) ◽

pp. 2473011420S0028

Author(s):

Ansab M. Khwaja ◽

Aditya Manoharan ◽

Ansab M. Khwaja ◽

Jacob Sorenson ◽

Cyrus V. Etebari ◽

...

Keyword(s):

Femoral Head ◽

Bone Loss ◽

Weight Bearing ◽

Treatment Algorithm ◽

Senior Author ◽

Duration Of Treatment ◽

Charcot Neuroarthropathy ◽

Staged Treatment

Category: Diabetes; Ankle; Diabetes; Hindfoot Introduction/Purpose: Charcot neuroarthropathy of the hindfoot (Brodsky type 2 and 3) can involve significant talar collapse / bone loss leading to hindfoot instability, the goal of treatment to create a stable plantigrade shoeable ulcer and infection free foot. This can often be achieved with tibiotalocalcaneal (TTC) arthrodesis but a plantigrade foot can be challenging in setting of significant talar bone loss. Structural allograft has been used in association with TTC fusions in a number of settings but not explored in the treatment of charcot hindfoot. The goal of this study was to examine the outcomes of structural allografting combined with TTC arthrodesis for the treatment of charcot hindfoot. Methods: Retrospective review of all patients treated at our institution with a Brodsky type 2 or 3 was performed over a five year period from 2014 - 2019. We identified twenty-two patients, 12 males and 10 females with a mean age of 57 years. All underwent surgery by the senior author, a fellowship trained foot and ankle orthopedic surgeon. Patients with infection were treated with antibiotics and a Taylor spatial frame prior to definitive stabilization. Non-infected patients were either placed in a total contact cast (TCC) if they were in active charcot or underwent primary charcot reconstruction. If after initial treatment patients had a plantigrade foot, they were placed in stiff soled rocker bottom shoe with custom accommodative insoles. Patients who did not have a plantigrade foot underwent TTC arthrodesis to achieve this. Femoral head allograft was used if excessive talar bone loss or collapse of the hindfoot was noted. Results: At final follow up 13 patients (59%) of the cohort achieved grade 1, an infection and ulcer free plantigrade foot that was able to fit in a shoe. 7 (32%) of patients achieved grade 2, a plantigrade foot in brace, and 2 (9%) achieved level 3 a plantigrade foot. No patients in this cohort underwent amputation. Average duration of treatment until final status was 18 months (minimum 2, maximum 37), number of interventions 3.9 (minimum 1, maximum 10). Of the twelve patients who required allograft, they averaged 4.25 interventions and average time of 17.6 months until final status. Of those who did not require allograft, they averaged 3.4 interventions with follow up of 11.9 months. Conclusion: Our data suggests that patients with Brodsky type 2 and 3 charcot arthropathy of the ankle and hindfoot even with infection can be successfully treated with staged treatment. This includes external fixation and infection management, followed by tibiotalocalcaneal intramedullary nail fixation with or without femoral head allograft to allow for a plantigrade foot and weight bearing in a stiff soled rocker bottom shoe. Further study is needed to determine long term outcomes and relapse rates.

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Surgical reconstruction in diabetic foot syndrome

Medical and Health Science Journal ◽

10.15208/mhsj.2010.108 ◽

2011 ◽

Vol 6 ◽

pp. 55-59

Author(s):

Telman Kamalov ◽

Saidganikhodzha Ismailov ◽

Zilola Dosova ◽

Khamidulla Shokirov ◽

Umid Shoyusupov ◽

...

Keyword(s):

Diabetic Foot ◽

Diabetic Foot Syndrome ◽

Surgical Reconstruction

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Risk Factors Associated With Complications After Operative Treatment of Multiligament Knee Injury

Orthopaedic Journal of Sports Medicine ◽

10.1177/2325967121994203 ◽

2021 ◽

Vol 9 (3) ◽

pp. 232596712199420

Author(s):

Neel K. Patel ◽

Jayson Lian ◽

Michael Nickoli ◽

Ravi Vaswani ◽

James J. Irrgang ◽

...

Keyword(s):

Risk Factors ◽

Knee Injury ◽

Treatment Algorithm ◽

Significant Risk ◽

Timing Of Surgery ◽

Surgical Reconstruction ◽

Fisher Exact Test ◽

Initial Surgery ◽

Multiligament Knee Injury ◽

Time From Injury

Background: Many factors can affect clinical outcomes and complications after a complex multiligament knee injury (MLKI). Certain aspects of the treatment algorithm for MLKI, such as the timing of surgery, remain controversial. Purpose: To determine the risk factors for common complications after MLKI reconstruction. Study Design: Case-control study; Level of evidence, 3. Methods: A retrospective review was conducted on 134 patients with MLKI who underwent reconstruction between 2011 and 2018 at a single academic center. Patients included in the review had a planned surgical reconstruction of >1 ligament based on clinical examination and magnetic resonance imaging. Complications were categorized as (1) wound infection requiring irrigation and debridement, (2) arthrofibrosis requiring manipulation under anesthesia and/or lysis of adhesions, (3) deep venous thrombosis, (4) need for removal of hardware, and (5) revision ligament surgery. The potential risk factors for complications included patient characteristics, injury pattern categorized according to Schenck classification (knee dislocation [KD] I–KD IV), and timing of surgery. Significant risk factors for complications were analyzed by t test, chi-square test, and Fisher exact test. Results: A total of 108 patients met the inclusion criteria; of these, 29.6% experienced at least 1 complication. Smoking (odds ratio [OR], 3.20 [95% CI, 1.28-8.02]; P = .01) and planned staged surgery (OR, 2.71 [95% CI, 1.04-7.04]; P = .04) significantly increased the overall risk of complication, while increased time from injury to surgery (OR, 0.99 [95% CI, 0.98-0.998]; P < .01) significantly decreased the risk. Increasing time from injury to surgery (OR, 0.99 [95% CI, 0.97-0.998]; P = .02) also led to a slightly but significantly decreased risk for arthrofibrosis. Conclusion: The study findings suggest that smoking, decreased time from injury to initial surgery, and planned staged procedures may increase the rate of complications. Further studies are needed to determine which changes in the treatment algorithm are most effective to reduce the complication rate in patients.

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