Clinics in podiatric medicine and surgery
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The goal of this article is to provide an introductory look into current concepts regarding chronic regional pain syndrome. Great advances have been made over the last 15 years, but we are far from a complete understanding of this disorder. This article places great emphasis on early clinical recognition and treatment intervention.
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Multidisciplinary pain management clinics provide the standard of care for the diagnosis, evaluation, and treatment of patients who have chronic pain. Primary care physicians are encouraged to maintain an active role in the care of patients after referral to these pain centers, often for long-term opiate therapy or complex regional pain syndrome. Insights into the role of pain management clinics after referral are discussed in this article.
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The podiatric physician often encounters complex painful neuropathies in daily practice. Diabetic neuropathy is one form of chronic neuropathic pain dealt with on a regular basis. The goal of this article is to review the pathophysiology, diagnosis, and treatment options of this complaint. Medical and surgical interventions are discussed, with a clinical emphasis on patient selection and prevention.
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Clin Podiatr Med Surg · Jul 2007
ReviewCurrent perioperative treatment of patients with type 1 and type 2 diabetes.
Diabetes mellitus is rapidly increasing, diabetic patients are likely to undergo surgical procedures more than non-diabetic patients, the hospital stay of diabetic patients is longer, and diabetic patients have increased mortality and morbidity. The correct treatment of diabetic patients in the perioperative period is crucial to improve clinical outcomes. ⋯ Metabolic control deserves great attention because hyperglycemia is related to increased complications and worse outcomes. Insulin infusion regimens to achieve near normoglycemia must be implemented in surgical and critically ill patients.
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Clin Podiatr Med Surg · Jul 2007
ReviewAdvanced plastic surgery techniques for soft tissue coverage of the diabetic foot.
Obtaining stable, durable, and functional wound closure of a diabetic foot wound or open pedal amputation through plastic surgical techniques is essential to limit the potential for repeated ulceration, infection, and "supra-pedal" amputation. Myriad conservative and surgical techniques can be used to obtain wound closure. The authors discuss their approach and present operative pearls for their most commonly employed plastic surgical techniques to provide adequate soft tissue coverage of diabetic foot wounds. Emphasis is placed on the techniques necessary to perform these procedures and the surgical thought process involved in closing diabetic foot wounds.