1/74. Treatment of late ulceration in free muscle flaps to the foot.One of the preferred methods for the repair of large defects of the foot has been the use of free muscle flaps covered with skin grafts. Although this method has served well, some patients will experience ulceration in the weight-bearing surface. Three cases are reported in which small ulcerations developed in the heel after reconstruction of traumatic defects with muscle free flaps. All three patients were treated with a neurovascular island flap from the side of the great toe. All three patients are active young males, and all three patients have subsequently maintained intact skin for an average of 6.8 years (range, 5.1 to 9.1 years).- - - - - - - - - - ranking = 1keywords = foot (Clic here for more details about this article) |
2/74. A simplified method of total contact casting for diabetic foot ulcers.A simplified method of total contact casting for diabetic plantar ulcerations is described in which a standard, well-molded short-leg walking cast is applied. Weekly cast changes are performed initially, followed by longer cast change intervals. Either fiberglass or plaster casting tape appears equally efficacious. Healing of all ulcers was demonstrated in 12 patients treated with this technique.- - - - - - - - - - ranking = 0.8keywords = foot (Clic here for more details about this article) |
3/74. mycosis fungoides masquerading as an ischemic foot.This case is of a man with bilateral lower-extremity ischemia and a solitary nonhealing ulcerated lesion of the right great toe. After revascularization with an aortobifemoral bypass, his right ABI increased from 0.5 to approximately 0.75, but the ulcerated toe lesion did not show signs of healing and instead progressed to a deeper ulceration exposing bone. Because of presumptive osteomyelitis, we performed a great toe amputation, and immunohistochemical analysis of the lesion revealed late plaque stage mycosis fungoides (MF). We present this case to alert the vascular surgeon to this diagnostic possibility when confronted with an apparent ischemic lesion and to describe what made this particular lesion suspicious for MF. To the best of our knowledge, this is the first case of MF presenting solely as an ischemic lesion.- - - - - - - - - - ranking = 0.8keywords = foot (Clic here for more details about this article) |
4/74. Reverse flow instep island flap.The retrogradely perfused medial plantar artery flap was used in a leprosy patient with a plantar ulcer over the heads of the second and third metatarsals. The flap is based on the anastomosis of the medial plantar artery with the branch of the first plantar metatarsal artery, which supplies the medial side of the great toe. This design provides reconstruction with like local tissues while not distorting the weight-bearing pattern of the foot.- - - - - - - - - - ranking = 0.2keywords = foot (Clic here for more details about this article) |
5/74. The effect of hallux valgus correction on chronic plantar ulceration. A case report.Plantar pressure-measurement technology may provide the clinician with valuable objective information for monitoring the effects of therapeutic intervention on the foot. The use of this technology is described in the preoperative and postoperative assessment of a patient undergoing hallux valgus surgery for the treatment of a chronic neuropathic skin ulcer over the medioplantar aspect of her first metatarsophalangeal joint.- - - - - - - - - - ranking = 0.2keywords = foot (Clic here for more details about this article) |
6/74. Soft-tissue reconstruction of sole and heel defects with free tissue transfers.Reconstruction of the weight-bearing surface of the foot is a challenging problem for the reconstructive surgeon. Because local tissues are not usually available for reconstruction, distant tissue transfers are often necessary. The authors report 20 patients with sole and heel defects that were reconstructed with free flaps. Two patients had bilateral reconstruction. Three patients were younger than 10 years. Etiological causes were burn scar (N = 7), trauma (N = 7), chronic wound (N = 3), and tumor resection (N = 5). All defects were located at a weight-bearing area. Gracilis muscle (N = 11), neurosensorial radial forearm (N = 7), latissimus dorsi muscle (N = 2), rectus abdominis muscle (N = 1), and posterolateral thigh flaps (N = 1) were used for reconstruction. Muscle flaps were preferred for the deep and irregular defects or chronic, open infected wounds. All flaps survived except for one total and two partial complications of necrosis. recurrence of ulceration was observed in 1 patient with spinal cord trauma. The mean follow-up period was 33.7 months (range, 1-84 months). patients were evaluated by direct gait observation, footprints, pedograms, and the Semmes-Weinstein monofilament test. All patients returned to normal daily activity with individual gait patterns. Functional outcomes of both muscle and fasciocutaneous flaps were satisfactory. Presence of deep sensation, preservation of musculoskeletal integrity, and patient compliance are the main factors for durability of reconstruction.- - - - - - - - - - ranking = 0.4keywords = foot (Clic here for more details about this article) |
7/74. Filleted toe flap for chronic forefoot ulcer reconstruction.Chronic plantar and dorsal forefoot ulcer may result from injury, structural deformity, and abnormal sensation or circulation. It is not uncommon that the distal portion of the affected toes is deficient functionally in these patients. A filleted toe flap from the expendable functionless toe can provide a durable, stable, and sensate skin flap of 4 to 5.5 cm for coverage of the forefoot defect. In this report, five cases of dorsal forefoot defects and four cases of plantar forefoot defects due to ischemia (N = 3), trophic change (N = 2), and diabetes (N = 4) were treated with filleted toe flaps. One flap failed due to postoperative deep infection. The other eight filleted toe flaps survived but 2 patients underwent secondary amputations 7 months and 2 two years later because of secondary diabetic foot infections.- - - - - - - - - - ranking = 1.8keywords = foot (Clic here for more details about this article) |
8/74. An unusual case of pemphigus vulgaris presenting as bilateral foot ulcers.We describe an unusual presentation of pemphigus vulgaris, an autoimmune intraepidermal blistering skin disease associated with autoantibodies to the desmosome glycoprotein, desmoglein 3. A 60-year-old man presented with bilateral ulceration on the dorsum of the feet. These clinical features persisted for 4 months before more characteristic signs of pemphigus vulgaris, including mouth ulceration and skin erosions, developed. The atypical presentation led to a delay in diagnosis and initiation of the appropriate treatment. pemphigus vulgaris may have unusual manifestations, such as nail dystrophy, paronychia, or granulation tissue-like lesions, but this case of bilateral foot ulceration highlights a further, perhaps unique, clinical presentation of this autoimmune disease.- - - - - - - - - - ranking = 1keywords = foot (Clic here for more details about this article) |
9/74. A new ambulatory foot pressure device for patients with sensory impairment. A system for continuous measurement of plantar pressure and a feed-back alarm.Abnormal and excessive plantar pressure is a major risk factor for the development of foot ulcers in patients with loss of protective pain sensation. Repeated pressure with each step can result in inflammation at specific points, followed by ulcer formation. patients with peripheral nerve disease are unable to prevent the development of such lesions, which often lead to amputation. For this reason, it has been suggested that a fundamental therapeutic intervention should be the reduction of high plantar pressure. We have developed a portable, battery-operated ambulatory foot pressure device (AFPD) which has two important functions: (1) to determine the areas of high plantar pressure, and (2) to provide an acoustic alarm, adjusted to a specific pressure load, which is triggered when weight-bearing exceeds the predetermined plantar pressure. A memory of plantar pressure parameters allows for downloading of the data and sequential analysis during the investigation period. Such an alarm device could replace the lack of pain sensation and may play an important role in the prevention of ulcer development and lower extremity amputation.- - - - - - - - - - ranking = 1.2keywords = foot (Clic here for more details about this article) |
10/74. Clinical applications of the posterior rectus sheath-peritoneal free flap.Soft-tissue injuries involving the dorsum of the hand and foot continue to pose complex reconstructive challenges in terms of function and contour. Requirements for coverage include thin, vascularized tissue that supports skin grafts and at the same time provides a gliding surface for tendon excursion. This article reports the authors' clinical experience with the free posterior rectus sheath-peritoneal flap foil dorsal coverage in three patients. Two patients required dorsal hand coverage; one following acute trauma and another for delayed reconstruction 1 year after near hand replantation. A third patient required dorsal foot coverage for exposed tendons resulting from skin loss secondary to vasculitis. In all three patients, the flap was harvested through a paramedian incision at the lateral border of the anterior rectus sheath. After opening the anterior rectus sheath, the rectus muscle was elevated off of the posterior rectus sheath and peritoneum. When elevating the muscle, the attachments of the inferior epigastric vessels to the posterior rectus sheath and peritoneum were preserved while ligating any branches of these vessels to the muscle. Segmental intercostal innervation to the muscle was preserved. The deep inferior epigastric vessels were then dissected to their origin to maximize pedicle length and diameter. The maximum dimension of the flaps harvested for the selected cases was 16 X 8 cm. The anterior rectus sheath was closed primarily with non-absorbable suture. Mean follow-up was 1 year, and all flaps survived with excellent contour and good function in all three patients. Complications included a postoperative ileus in one patient, which resolved after 5 days with nasogastric tube decompression.- - - - - - - - - - ranking = 0.4keywords = foot (Clic here for more details about this article) |
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