Foot & ankle international
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The purpose of this study is to report our experience with the Vacuum Assisted Closure (VAC) negative pressure technique in patients with non-healing wounds of the foot, ankle, and lower limb. We retrospectively reviewed 17 patients with non-healing wounds of the lower extremity who underwent treatment using the Vacuum Assisted Closure (VAC) device. Thirteen of 17 (76%) had diabetes mellitus, nine of whom were insulin-dependent, and 10 of whom had associated peripheral neuropathy. ⋯ Our results indicate that the Vacuum Assisted Closure negative pressure technique is emerging as an acceptable option for wound care of the lower extremity. Not all patients are candidates for such treatment; those patients with severe peripheral vascular disease or smaller forefoot wounds may be best treated by other modalities. Larger wounds seem to be better suited for skin grafting or two-stage primary closure.
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A wealth of clinical and experimental data suggests, that anatomical restoration of the posterior calcaneal facet is a major predictor of outcome after intra-articular calcaneus fractures. The value of subtalar arthroscopy was examined in three clinical study groups (I-III. ⋯ Subtalar arthroscopy provides a most precise and thorough view of the posterior facet of the calcaneus both in assessing the quality of initial reduction as well as evaluation during hardware removal after intra-articular calcaneus fractures. It is more precise than intra-operative fluoroscopy and less time consuming than standard Brodén views during surgery. The use of arthroscopy allows anatomical percutaneous reduction and screw fixation of Sanders II fractures. It therefore provides a useful additional tool in treating intra-articular calcaneus fractures.
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Case Reports
Floating lesser metatarsals associated with Lisfranc type C--total displacement injury.
We present a 30-year-old woman with a complex foot injury including floating lesser metatarsals, an intact base of second metatarsal and an irreducible fifth metatarsophalangeal joint. The recognition of potential associated injuries together with a Lisfranc fracture-dislocation must not be overlooked.
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We developed a continuous lateral sciatic nerve infusion technique for postoperative analgesia. ⋯ Continuous lateral sciatic infusion of 0.2% ropivacaine represents an alternative for acute postoperative pain control after major ankle and foot surgery.
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Comparative Study
Healing of Achilles tendon, an experimental study: part 2--Histological, immunohistological and ultrasonographic analysis.
In 105 rabbits the course of healing was examined at one, two, four, eight and 12 weeks (21 rabbits per group) after an experimental Achilles tendon rupture. The following treatment modalities were compared: A) primary functional treatment; B) operative functional treatment (resorbable suture); and C) operative functional treatment with fibrin glue. For the functional (after)-treatment a special orthosis was applied. ⋯ The echogenicity of the tendon during the course of healing showed increasing homogeneity and parallelism in all groups. At 12 weeks the echogenicity was comparable in all groups. The experiment suggests the equivalence of primary functional treatment to a combination of operative and functional therapy in Achilles tendon rupture.