Cases reported "Foot Injuries"

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1/14. replantation of the midfoot in a child--six-year follow-up with pedobarographic analysis.

    A 22-month old child underwent successful replantation of her midfoot at the level of Chopart's joint after a traumatic lawn mower amputation. The child demonstrated good sensation and function. heel-to-toe length was 2 cm shorter, along with anterior migration of the heel pad on the injured foot. Pedobarographic analysis at 6-year follow-up demonstrated a normal range in the dynamic distribution of foot pressure measurements, except in the region of the medial heel. With replantation more commonly considered as an option in traumatic injuries, long-term functional evaluation is important in demonstrating the success of a replantation. The patient demonstrated a good result at 6-year follow-up, but will need further evaluation until skeletal maturity is reached.
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keywords = pressure
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2/14. Comparison between sensitive and nonsensitive free flaps in reconstruction of the heel and plantar area.

    In this study, 12 cases of reconstruction of the heel and plantar area since 1982 are reviewed. Six nonsensate muscle free flaps and six sensate fasciocutaneous flaps were used, respectively. Categories assessed were the time interval for return to daily living activities, sensation to light touch, pinprick, Semmes-Weinstein monofilament test of the reconstructed area for sensory evaluation; and results of pedograms (maximal pressure, pressure distribution, and total contact area of the plantar surface). Follow-up periods were between 2 and 14 years, with an average of 6 years. Better sensory results and early return to daily living activities were observed in the sensate flap group, but the defects were smaller in this group. Despite the slightly longer time to return to daily living activities and worse sensory results, long-term follow-up showed that patients with nonsensate flaps had no difficulty in performing living activities if they continued to be careful and to use some kind of protective shoes. The results of the pedogram analyses were similar between the two groups with regard to total contact area of the reconstructed foot in relation to the healthy foot. pressure values of the reconstructed areas in sensate flaps were found to be close to pressure values in the same weight areas of the normal foot. The differences between pressure values of the sensate and nonsensate flaps were statistically significant (p < 0.001). Therefore, in reconstruction of the weight-bearing surface of the foot, each case should be evaluated individually. The reconstructive method should be chosen according to the location and soft-tissue requirements of the defect.
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ranking = 4
keywords = pressure
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3/14. Acute traumatic compartment syndrome of the foot in children.

    Acute traumatic compartment syndrome of the foot is a sequelae of serious injury to the foot, which, if unrecognized, may result in significant motor and sensory deficits, pain, stiffness, and deformity. It is nearly always associated with fractures, dislocations, and crush injuries to the foot. Vascular injuries and coagulopathic states are also risk factors for the development of an acute foot compartment syndrome. In children, the presentation of an acute foot compartment syndrome may be masked by the pain and edema caused by associated fractures and dislocations. A high index of suspicion is warranted in children presenting with foot injuries that are associated with foot compartment syndrome. Recognition of the signs and symptoms of compartment syndrome in the emergency room are paramount; the diagnosis is best confirmed by multiple compartment pressure readings. The urgency of diagnosis of a compartment syndrome must be underscored, as the complications of a missed foot compartment syndrome includes contractures, claw toe deformity, sensory loss, stiffness, and chronic pain. Prompt orthopaedic consultation is mandatory; urgent compartment fasciotomies are associated with a good clinical outcome.
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keywords = pressure
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4/14. Versatility of the distally based superficial sural flap for reconstruction of lower leg and foot in children.

    Twenty children are presented after undergoing a distally based superficial sural flap for coverage of defects at the lower leg and foot. The age of the patients was between 1 and 12 years. Fifteen patients had trauma to the lower leg, with eight of them having associated injuries. Three had postburn contracture and two had pressure sore. In 14 cases, the flap was used as a fasciocutaneous flap, whereas in six cases it was used as a fascial flap covered with a skin graft. The flaps were used to cover the defects from the dorsum of the foot distally up to the mid third of tibia proximally. The mean follow-up was for a period of 2 years. Even though free tissue transfer is reliable and safe for the reconstruction of major leg injuries in children, the distally based superficial sural flap has the advantage of being easy to perform, with short operating time, minimal donor side morbidity, and preservation of major arteries of the leg.
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5/14. High pressure industrial steam washer injury resulting in digital amputation.

    High pressure washers are increasingly used to clean industrial machinery. We report a case of severe full skin thickness burn resulting from momentary exposure to the jet of steam.
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ranking = 5
keywords = pressure
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6/14. Change of weight-bearing pattern before and after plantar reconstruction with free anterolateral thigh flap.

    We reconstructed a large-sized defect at the weight-bearing plantar region by a free anterolateral thigh flap successfully. This is the first case report of using the anterolateral thigh flap for reconstruction of the plantar foot. Based on the preoperative and postoperative pedogram examinations, the pressure distribution on the weight-bearing area reconstructed by the transferred flap was obviously improved and demonstrated a nearly normal pattern. No previous report has compared the weight-bearing pattern before and after large plantar reconstruction with a free flap. The anterolateral thigh free flap, which provides adequate bulk and contour of the foot, and which withstands weight pressure and shearing force and has the ability to provide recovery of sensation, is considered a good alternative in covering a large weight-bearing plantar defect.
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ranking = 2
keywords = pressure
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7/14. Extended trapezius myocutaneous free flap for the reconstruction of a foot defect lacking adjacent recipient vessels.

    Foot reconstruction requires tissue that is durable and can withstand the extremes of pressure and stress. The trapezius myocutaneous flap has not been used previously as a free flap for foot reconstruction. In this report, the trapezius was used as an extended myocutaneous free flap for the reconstruction of a foot wound lacking adjacent and adequate recipient vessels. The extended trapezius flap may be one of the longest free flaps that can be harvested. The indications for the use of this flap are limited. In an extremity that lacks adequate recipient vessels adjacent to the defect, this flap can be extended such that more proximal vessels in the leg can be used as the recipient vessels without the need for vein grafts to bridge the distance. The donor-site morbidity of this flap is minimal when the superior fibers of the trapezius muscle and its innervation are preserved.
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ranking = 1
keywords = pressure
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8/14. The neuropathic foot--a management scheme: a case report.

    The purpose of this case report is to present a management approach that was effective in the healing and long-term care of a neuropathic plantar ulcer in a patient with diabetes mellitus. The report demonstrates that a successful management program must go beyond the stage of healing and include patient education and techniques for reducing plantar pressures to prevent the recurrence of plantar ulcers.
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ranking = 1
keywords = pressure
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9/14. Treatment of high-pressure water gun injection injury of the foot with adjunctive hyperbaric oxygen: a case report.

    High-pressure injection injuries are reported often in the hand and occasionally in the foot. Injection with water and air causes minimal tissue damage but nevertheless requires irrigation, minimal debridement, administration of antibiotics, and concern for development of compartment syndrome. The outcome for patients injected with water and air should be excellent. Adjunctive hyperbaric oxygen causes immediate resolution of subcutaneous emphysema, edema, and pain for more rapid rehabilitation.
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ranking = 5
keywords = pressure
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10/14. acinetobacter calcoaceticus foot infection secondary to high-pressure injection injury: a case report.

    Injection injuries are surgical emergencies occurring most often in the hand and frequently associated with widespread tissue necrosis and infection. This report presents a case of high-pressure injection injury of the foot associated with extensor hallucis longus laceration and infection with acinetobacter calcoaceticus variant anitratus. This injury occurred with a high-pressure "water-blaster" tool used to remove paint from pavement. Similar injuries in the foot have not been reported. A. calcoaceticus is a widely distributed normal flora of low virulence, often waterborne, which is rarely found in orthopaedic infections in young healthy patients. Clinical features of high-pressure injection injuries, principles of treatment, and the characteristics of A. calcoaceticus are reviewed.
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ranking = 7
keywords = pressure
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