Clinics in podiatric medicine and surgery
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Fracture-dislocation of the tarsometatarsal joint is a major injury and can be associated with a chronic disability. The incidence is low, but the long-term results can be a devastating problem to the patient. This article reviews the anatomy, mechanism of injury, classifications, diagnostic procedures, treatment, and long-term results of a fracture-dislocation to the tarsometatarsal joint complex.
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Treatment of wounds in the diabetic foot presents a set of difficult problems that requires "out of the box" thinking. The traditional approach of off-loading these wounds is often expensive, time-consuming, and in some cases seemingly never ending. The literature speaks loudly for a change in the philosophy of treating chronic wounds. When developing a team to treat chronic diabetic wounds, a reconstructive foot and ankle surgeon trained in these techniques is an appropriate addition to the team.
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Clin Podiatr Med Surg · Apr 2003
ReviewCurrent trends in preoperative patient evaluation and management for podiatric surgeons.
In preparation for elective foot and ankle surgery, the podiatric surgeon often will refer the patient for a preoperative evaluation. Surgeons rely on the input of that consultant to provide a determination as to the operative risk for the patient. This article reviews the fundamental parts of the preoperative evaluation, perioperative patient management, and recent changes and trends within this arena.
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There are many options for perioperative pain control available to surgeons. Given these options, adequate levels of analgesia should be achieved and maintained in all surgical patients. Data suggest that analgesia may be improved by combining different analgesic approaches. ⋯ A multimodal recovery program consists of three major components: (1) early mobilization, (2) complete perioperative analgesia, and (3) early oral nutrition. The goal of multimodal programs is to accelerate patient rehabilitation and reduce hospital stays. Balanced multimodal programs are the present and future of perioperative pain control and will enhance patient care.
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Clin Podiatr Med Surg · Apr 2003
Review Case ReportsPostoperative cryotherapy: risks versus benefits of continuous-flow cryotherapy units.
Continuous-flow cryotherapy units have been proved to decrease pain, inflammation, swelling, blood loss, and narcotic usage in the postoperative setting. Complications related to cryotherapy are extremely rare (estimated at 0.00225%) but can be devastating. ⋯ All members involved with care of the patient, including the physician, nursing staff, patient, and patient's family and caregivers, should take an active roll in monitoring the foot for signs and symptoms of cold injury. Continuous-flow cold therapy should be discontinued when capillary refill time is greater than 5 seconds.