Plantar Fibromatosis: A Review of Primary and Recurrent Surgical Treatment

1995 ◽  
Vol 16 (9) ◽  
pp. 548-551 ◽  
Author(s):  
Keith L. Wapner ◽  
Prodromos A. Ververeli ◽  
John H. Moore ◽  
Paul J. Hecht ◽  
Carl E. Becker ◽  
...  
Keyword(s):  
Surgical Techniques ◽  
Major Complication ◽  
Primary Group ◽  
Split Thickness Skin Graft ◽  
Consecutive Series ◽  
Revision Procedure ◽  
Thickness Skin ◽  
Plantar Fibromatosis ◽  
Revision Operations

Plantar fibromatosis can be quite disabling to the patient, as well as a technical challenge to the surgeon. Patients who undergo previous local excisions and in whom aggressive recurrences develop are difficult to manage successfully. We present a consecutive series of five primary procedures on patients with painful plantar fibroma and seven revision operations on patients with recurrent plantar fibroma. The average follow-up was 47 months (range, 22–66 months) in the primary group and 40 months (range, 21–78 months) in the revision group. The overall results were satisfactory in four of the five primary operations, with only one recurrence. In the revision group, five of seven results were satisfactory with no recurrences. The major complication that led to unsatisfactory results was the development of a postoperative neuroma. In this article, we outline our present surgical techniques of wide primary excision and a staged revision procedure with delayed split-thickness skin graft closure. These techniques can be used successfully to manage this disabling, progressive disease.

scholarly journals Wound coverage of plantar metatarsal ulcers in leprosy using a toe web flap

2005 ◽  
Vol 38 (02) ◽  
pp. 123-127
Author(s):  
J Joshua ◽  
V Chakraborthy
Keyword(s):  
Skin Graft ◽  
Metatarsophalangeal Joint ◽  
Wound Dehiscence ◽  
Split Thickness Skin Graft ◽  
Wound Coverage ◽  
Thickness Skin ◽  
Secondary Defect ◽  
Metatarsophalangeal Joints

ABSTRACTPlantar metatarsal ulcers and sinuses are frequently seen problems in anaesthetic feet in leprosy. They may occur singly or as multiple sinuses. Many flaps have been described in the management of small defects of the forefoot. During the course of four years, from March 2000 to February 2004, a total of 708 plantar metatarsal ulcers in anaesthetic feet due to leprosy were seen. 280 surgeries were performed on 257 cases. Most of these were debridement and or excision of the metatarsophalangeal joints through a dorsal incision. Thirteen cases were dealt with by a toe web flap, using the plantar metatarsal artery as the source of supply to the flap. Nine were to cover defects under the 1st metatarsophalangeal joint. Three were to cover defects under the second and third metatarsophalangeal joints and one involved coverage of a defect under the 5th metatarsophalangeal joint. In all cases except the last, the big toe contributed the flap. In the last case the fourth toe was the donor. In all cases the flaps survived and did well. The secondary defects were covered with split thickness skin graft. Wound dehiscence was seen in one case and recurrence of a sinus, was seen in one case. Hyperkeratosis of the secondary defect was seen in three cases. Follow up ranged from 3 years to six months. We found this flap to be durable and safe with little chance of recurrence when used to cover plantar metatarsal ulcers.

Dorsal Adipofascial Turn-Ovesr Flap for Fingertip Amputations

1999 ◽  
Vol 24 (5) ◽  
pp. 525-530 ◽  
Author(s):  
R. E. ÜNLÜ ◽  
A. S. MENGI ◽  
U. KOÇER ◽  
Ö. SENSÖZ
Keyword(s):  
Pedicled Flap ◽  
Split Thickness Skin Graft ◽  
Early Recovery ◽  
Step Procedure ◽  
Thickness Skin ◽  
Exposed Bone ◽  
One Step ◽  
The Mean ◽  
Turn Over

We designed a dorsal adipofascial pedicled flap to cover amputations of the tip of the same digit. This flap includes all the adipofascial tissues from the dermis to the paratenon of the extensor tendons. After elevation of the skin, the adipofascial tissues are raised as a flap and turned over to resurface the exposed bone or joint and then covered with a split thickness skin graft. Ten digital amputations between the distal phalanx proximal to the nail matrix and the mid portion of the middle phalanx were successfully resurfaced with dorsal adipofascial turn-over flaps. All flaps survived completely and the mean follow-up was 11 months. This one-step procedure would seem to be a relatively simple way of achieving early recovery because it does not require the use of distant flaps immobilization of adjacent digits, or homodigital flaps that might jeopardize an already injured finger.

scholarly journals Ten-Year Results of Primary and Revision Condylar-Constrained Total Knee Arthroplasty in Patients with Severe Coronal Plane Instability

2015 ◽  
Vol 9 (1) ◽  
pp. 379-389 ◽  
Author(s):  
Andrea Camera ◽  
Stefano Biggi ◽  
Gabriele Cattaneo ◽  
Giovanni Brusaferri
Keyword(s):  
Interquartile Range ◽  
Coronal Plane ◽  
Primary Group ◽  
Consecutive Series ◽  
Implantation Time ◽  
Condylar Implant ◽  
Cortical Hypertrophy ◽  
Total Knee ◽  
Revision Tka

Objective : To retrospectively review the results at minimum ten years after surgery of a consecutive series of total knee arthroplasties (TKAs) performed using a constrained condylar implant in patients with severe coronal plane instability. Materials and Methods : The series comprised of 44 patients (45 knees) who received primary (19 knees) or revision (26 knees) TKA with a constrained condylar implant between 2001 and 2003 at a single institution. Results : There were no revisions or any other surgery related complications at a mean implantation time of 11.0 years. In 38 patients (15 knees in the primary group and 24 knees in the revision group) who were available for clinico-radiographic follow-up at a minimum of ten years, there was no sign of radiographic loosening. Two patients showed cortical hypertrophy at the extension stem tip but none complained of pain around the stem tip. According to the TLKSS score grading, 73% of the patients in the primary group had results categorized as good or excellent, while 54% of the patients in the revision group had fair results. Four patients (one (7%) in the primary group and three (13%) in the revision group) had poor results. The median WOMAC Index was 80.2% (interquartile range: 74.0% - 81.2%) and 74.0% (interquartile range: 72.1% - 75.8%) in the primary and in the revision groups, respectively (p=0.010). Conclusion : This study showed satisfactory clinical outcomes with no re-operations at minimum ten years after implantation in patients who had undergone primary or revision TKA with a condylar constrained implant.

scholarly journals Long-term outcomes for 2-stage urethroplasty: an analysis of risk factors for urethral stricture recurrence

2021 ◽  
Author(s):  
James R. Furr ◽  
Eric S. Wisenbaugh ◽  
Joel Gelman
Keyword(s):  
Risk Factors ◽  
Success Rate ◽  
Skin Graft ◽  
Long Term Results ◽  
Split Thickness Skin Graft ◽  
Thickness Skin ◽  
Patient Reported ◽  
Early Success

Abstract Purpose To report long-term results and patient reported outcomes of staged anterior urethroplasties, and isolate risk factors for recurrence. Methods  We reviewed urethroplasty database for all patients who underwent staged urethroplasty from 2000 to 2017. Follow-up included a cystoscopy 4 months after their 2nd stage to assess early success, and then annual follow-up thereafter with post-void residual and symptom assessment. Stricture characteristics, etiology and graft type were analyzed with regards to success. Results  Forty-nine patients were eligible for inclusion. The median stricture length was 7 cm (3–17 cm). The early success rate demonstrated by cystoscopy at 4 months was 100%. Long-term success was 96.4% in buccal graft (BMG) only patients; however, long-term success fell considerably to 53% in patients requiring any use split thickness skin graft (STSG) in the first stage. Median follow up time was 57 months (6–240 months). On analysis, age, increased stricture length and especially the use of STSG all appeared to be associated with late recurrence. The recurrence group had longer stricture length and were more likely to be panurethral. All recurrences occurred after the initial 4-month cystoscopy with a median time to recurrence of 78 months. Conclusion Staged repairs that are amenable to BMG-only repairs have high long-term success rates. Increasing stricture length and the addition of split-thickness skin graft were associated with lower success rate in staged urethral reconstruction. Patients requiring staged repairs often experience recurrence in a very delayed fashion reinforcing the need for close, long-term follow up.

scholarly journals Surgical management of vaginal agenesis using a modified Mc Indoe’s technique: VIMS experience

2017 ◽  
Vol 6 (9) ◽  
pp. 3841
Author(s):  
Chandrashekhar Tharihalli ◽  
Muralikrishna V. ◽  
Shiva Kumar H. C.
Keyword(s):  
Skin Graft ◽  
Split Thickness Skin Graft ◽  
Success Rates ◽  
Vaginal Agenesis ◽  
Vaginal Reconstruction ◽  
Obstetrics And Gynaecology ◽  
Vaginal Length ◽  
Thickness Skin ◽  
Müllerian Agenesis

Background: Mullerian agenesis is a challenge to reconstructive surgeons. In order to create a new vagina that mimic the normal one in size, lining and appearance, multiple techniques have been designed; among these techniques Mc Indoe’s vaginoplasty represents the simplest one with good results. Mc Indoe’s operation which involves the creation of a space between bladder and rectum, insertion of a mould covered with split-thickness skin graft into that neo-vaginal space, and use of postoperative vaginal mould for dilation and to avoid stenosis. However, many modifications have been introduced in time in an attempt to increase the success rates. The purpose of vaginal agencies treatment is to create an adequate passage for penetration during sexual intercourse.Methods: Between Jan 2010 to June 2017, ten patients with vaginal agenesis were admitted to Dept of Obstetrics and Gynaecology, VIMS Ballari for vaginal reconstruction. All cases underwent a modified Mc Indoe’s technique, and follow up was done for one year.Results: All ten cases of vaginal agenesis underwent vaginal reconstruction by modified Mc Indoe's technique. Post-operative vaginal length varied from 5 to 7 cm in patients who used mould regularly. Successful skin graft take was achieved in 6 cases. one case of perforation of rectum and one case of vaginal stricture was noted.Conclusions: To optimize sexual comfort, the clinical management of women with vaginal agenesis must be multidisciplinary and individually tailored. Our findings suggest that the modified Mc Indoe’s technique is a simple, effective procedure for the treatment of vaginal agenesis, but proper mould usage after surgery remains the cornerstone of the treatment.

Split-Thickness Skin Grafts for Closure of Diabetic Foot and Ankle Wounds

2010 ◽  
Vol 3 (5) ◽  
pp. 231-240 ◽  
Author(s):  
Crystal L. Ramanujam ◽  
John J. Stapleton ◽  
Krista L. Kilpadi ◽  
Roberto H. Rodriguez ◽  
Luke C. Jeffries ◽  
...  
Keyword(s):  
Surgical Outcome ◽  
Wound Closure ◽  
Smoking History ◽  
Surgical Reconstruction ◽  
Split Thickness Skin Graft ◽  
Diabetic Patients ◽  
Skin Grafts ◽  
Foot And Ankle ◽  
Thickness Skin

The aim of this study was to determine if split-thickness skin grafts could be successfully used for closure of foot and ankle wounds in diabetic patients. The authors retrospectively reviewed the charts of 100 consecutive patients who underwent a soft tissue surgical reconstruction with split-thickness skin grafts to their foot and/or ankle in our institution from 2005 to 2008. After application of inclusion criteria, 83 eligible charts remained. Of the 83 patients, 54 (65%) healed uneventfully, 23 (28%) required regrafting, and 6 (7%) had a complication resolved with conservative management. All patients had a successful surgical outcome, defined as having achieved complete wound closure at the final follow-up. Surgical outcome was not significantly associated with age, gender, race, hemoglobin A1C, wound size, wound location, illicit drug use, amputation history, Charcot history, or preoperative infection. However, postoperative graft complications were significantly associated with current or previous smoking history (P = .016) and the level of previous pedal amputation to which the split-thickness skin graft was applied (P = .009). This study demonstrates that application of split-thickness skin grafts with an appropriate postoperative regimen is a beneficial procedure to achieve foot and ankle wound closure in diabetic patients.

Primary chordomas of the cervical spine: a consecutive series of 14 surgically managed cases

2012 ◽  
Vol 17 (4) ◽  
pp. 292-299 ◽  
Author(s):  
Yu Wang ◽  
Jianru Xiao ◽  
Zhipeng Wu ◽  
Quan Huang ◽  
Wending Huang ◽  
...  
Keyword(s):  
Cervical Spine ◽  
Local Recurrence ◽  
Tumor Recurrence ◽  
Postoperative Radiotherapy ◽  
Survival Rates ◽  
Surgical Techniques ◽  
Consecutive Series ◽  
Tumor Seeding ◽  
Upper Cervical

Object Cervical chordomas are rare lesions and usually bring about challenges in treatment planning because of their wide extension and complicated adjacent anatomy. There are few large published series at present focusing on cervical chordomas. The authors studied a consecutive series of 14 patients with primary cervical chordomas who underwent surgical treatment and were observed between 1989 and 2008. By reviewing the clinical patterns and follow-up data, they sought to investigate the clinical characters, tailor the appropriate surgical techniques, and establish prognosis factors for cervical chordomas. Methods Hospitalization and follow-up data in the 14 patients were collected. All patients underwent piecemeal tumor excision and reconstruction for stability; total spondylectomy was achieved in 5 cases. Postoperative radiotherapy was administered in all patients. Kaplan-Meier plots were used to represent tumor recurrence and patient survival, and log-rank testing was used to determine the risk factors of local recurrence. Results Follow-up ranged from 8 to 120 months (mean 58.6 months). Symptom and neural status in most patients improved after surgery. The 1- and 5-year disease-free survival rates were 78.6% and 50%, respectively, and the 1- and 5-year survival rates were 92.9% and 85.7%, respectively. Log-rank tests revealed that the following variables were significantly associated with a high rate of tumor recurrence: age less than 40 years or greater than 70 years (p = 0.006) and an upper cervical tumor location (p = 0.019). Conclusions Chordomas in the cervical spine are usually neoplasms that exhibit insidious growth and a wide extension by the time of diagnosis. Radical intralesional debulking surgery and postoperative radiotherapy have been effective treatment. A limited application of en bloc tumor resection and the highly likely intraoperative intralesional tumor seeding may partially explain the high local recurrence rate, whereas the chance of distant metastases, fortunately, is very low. Most recurrence were documented within 3 years. Some specific surgical techniques should be emphasized to minimize tumor seeding. Patients with upper cervical chordomas, younger adults, and elderly adults have worse prognosis. For patients with chordoma extending to both the anterior and posterior spinal columns, total spondylectomy combined with piecemeal excision is recommended for a better prognosis.

554 A Comparison of Intact Piscine Skin, Split-thickness Skin Graft, and Lactic Acid Membrane in Treating Superficial and Deep Burn Wounds Following Enzymatic Debridement

2021 ◽  
Vol 42 (Supplement_1) ◽  
pp. S125-S126
Author(s):  
Christoph Wallner ◽  
Jana Holtermann ◽  
Marius Drysch ◽  
Johannes Maximilian Wagner ◽  
Mehran Dadras ◽  
...  
Keyword(s):  
Wound Healing ◽  
Lactic Acid ◽  
Skin Graft ◽  
Healing Process ◽  
Split Thickness Skin Graft ◽  
Burn Wounds ◽  
Thickness Skin ◽  
Follow Up Care ◽  
Enzymatic Debridement

Abstract Introduction The optimal therapy for deep burn wounds is based on the principle of rapid necrectomy and coverage in order to achieve healing that is as scar-free as possible. The available infrastructure and the patient’s condition represent limitations. With enzymatic debridement, selective bedside debridement can now be performed, however the optimal cover after enzymatic debridement has not been elucidated to date. In this study we compare superficial dermal and deep dermal wounds, which are either covered with lactic acid membrane, piscine skin, or split-thickness skin graft. To validate our approach the healed burn wounds were examined for objective (elasticity, water content, sebum, wound healing) and subjective skin quality as part of our standard follow-up care. Methods In this study, 12 patients who had received piscine skin, lactic acid membrane, or split-thickness skin graft after enzymatic debridement were retrospectively examined objectively and subjectively for scar quality as part of follow-up care 12 months after the accident. The wound healing process was also documented. Results Acceleration of wound healing was observed with the application of piscine skin vs split-thickness skin graft or lactic acid membrane. Skin elasticity was comparable to that of split-thickness skin graft but significantly better than lactic acid membrane. The sebum production in wounds treated with piscine skin was higher compared to lactic acid membrane covered wounds. The water storage capacity in the piscine skin treated wounds was also significantly higher than in lactic acid membrane or split-thickness skin graft treated wounds. Using the POSAS score, an improvement in elasticity, thickness, pigmentation, and relief was shown in piscine skin treated wounds, as well as a reduction in pain and itching, compared to split-thickness skin graft or lactic acid membrane. Conclusions The use of intact piscine skin immediately following enzymatic debridement in burn wounds results in faster wound healing and better patient outcomes compared to split-thickness skin graft or lactic acid membrane.

Advances in the use of electrospun nanofibrous polymeric matrix for dermal healing at the donor site after the split-thickness skin graft excision: a prospective, randomized, controlled, open-label, multicenter study

2021 ◽  
Author(s):  
Josef Haik ◽  
Yehuda Ullman ◽  
Eyal Gur ◽  
Dean Ad-El ◽  
Dana Egozi ◽  
...  
Keyword(s):  
Adverse Events ◽  
Skin Graft ◽  
Wound Care ◽  
Donor Site ◽  
Control Group ◽  
Split Thickness Skin Graft ◽  
Open Label ◽  
Thickness Skin ◽  
And Control

Abstract Dressings used to manage donor site wounds have up to 40% of patients experiencing complications that may cause suboptimal scarring. We evaluated the efficacy and safety of a portable electrospun nanofibrous matrix that provides contactless management of donor site wounds compared with standard dressing techniques. This study included adult patients who underwent an excised split-thickness skin graft with a donor site wound area of 10-200 cm 2. Patients were allocated into two groups; i.e., the nanofiber group managed with a nanofibrous polymer-based matrix, and the control group managed using the standard of care such as Jelonet® or Biatain® Ibu dressing. Primary outcomes were postoperative dermal healing efficacy assessed by Draize scores. The time to complete re-epithelialization was also recorded. Secondary outcomes included postoperative adverse events, pain, and infections during the first 21-days and extended 12-month follow-up. The itching and scarring were recorded during the extended follow-up (months 1,3,6,9,12) using Numerical-Analogue-Score and Vancouver scores, respectively. The nanofiber and control groups included 21 and 20 patients, respectively. The Draize dermal irritation scores were significantly lower in the nanofiber vs. control group (Z=-2.509; P=0.028) on the first postoperative day but became similar afterward (Z≥-1.62; P≥0.198). In addition, the average time to re-epithelialization was similar in the nanofiber (17.9±4.4 days) and control group (18.3±4.5 days) (Z=-0.299; P=0.764), so were postoperative adverse events, pain, and infection incidence, itching and scarring. The safety and efficacy of electrospun nanofibrous matrix are similar to standard wound care allowing its use as an alternative donor site dressing following the split-thickness skin graft excision.

The Use of a 95° Blade Plate and a Posterior Approach to Achieve Tibiotalocalcaneal Arthrodesis

2002 ◽  
Vol 23 (8) ◽  
pp. 704-710 ◽  
Author(s):  
Travis W. Hanson ◽  
Andrea Cracchiolo
Keyword(s):  
Pain Relief ◽  
Internal Fixation ◽  
Posterior Approach ◽  
Split Thickness Skin Graft ◽  
Blade Plate ◽  
Thickness Skin ◽  
Solid Fusion ◽  
Post Traumatic ◽  
Hindfoot Deformity

Various types of internal fixation have been used to achieve arthrodesis of both the ankle and subtalar joints. We have investigated the use of a standard 95° angled blade plate as a method of more rigid internal fixation to achieve arthrodesis of these joints. The purpose of this retrospective study was to review our clinical and radiographic results in adults using a blade plate applied through a posterior approach to fuse the ankle and subtalar joints. Methods: Between April 1995 and June 2000, 10 tibiotalocalcaneal arthrodeses were performed using a posterior approach and a blade plate for internal fixation. There were 10 adults (five men and five women) whose average age was 64 years (range, 42 to 80 years). The indication for the procedure was severe pain which was unresponsive to nonoperative management in patients with arthritic joints. Preoperative diagnoses included six patients with post-traumatic arthritis, two with primary degenerative arthritis, one with rheumatoid arthritis, and one with post-polio deformity. An average of 1.7 previous operations had been performed on the affected ankle. Results: Clinical and radiographic follow-up was performed for all patients at an average of 37 months (range, 12 to 71 months) postoperatively. All 10 patients achieved a solid fusion. The mean time to radiographic fusion was 14.5 weeks (range, 9 to 26 weeks). The operation resulted in plantigrade feet in all patients with an average tibia-floor angle of 2.3° of dorsiflexion and an average of 5° of hindfoot valgus. Patients had excellent pain relief, however function did not improve as much. Complications occurred in three patients. One patient required a small split-thickness skin graft for wound healing, one experienced a transient posterior tibial nerve neuropraxia, and one developed a deep venous thrombosis in the nonoperative leg at six weeks postoperatively. Three patients required removal of the blade plate because of discomfort, which promptly cleared. Conclusions: Arthrodesis provides excellent pain relief for patients with painful arthritic deformities of the ankle and subtalar joints. Using a posterior approach, a blade plate for internal fixation and bone grafts resulted in a solid fusion for all our patients. This method is particularly effective in large patients with a mild-moderate hindfoot deformity.

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