Wall-Suction Assisted Vacuum Sealing for Treatment of Infected Diabetic Foot Ulcer / 대한족부족관절학회지

PURPOSE: The infected diabetic foot patients were reviewed to analyze the result of new dressing methods using a wall-suction instruments. MATERIALS AND METHODS: Eighteen patients treated with wall-suction assisted vacuum dressing were included. After debridement under local anesthesia, a sponge pad, a drain, and a surgical drape were used to seal the wound. Negative pressure applied by the wall-suction at around 200 mmHg and dressing were repeated in every two to three days. The results of repeated wound cultures, growth of granulation tissues, and CRP level were closely observed on the regular basis. RESULTS: Rapid growth of granulation tissues was noticed around the wound in 16 cases. No organism was obtained in an average 5 days and wound coverage was possible in an average 18 days. The CRP level returned to normal in an average 4 weeks. Two patients with end stage renal disease, who were regularly hemodialised, underwent major amputation. CONCLUSION: New dressing method has the following advantages: a rapid wound improvement in the patients with infected diabetic foot, less expensive, less painful, impediment of bacterial contamination in the hospital room. However, further study will be needed for the end stage renal disease patients.

Progressive Dynamic Equinovarus Deformity in Hereditary Spastic Paraplegia: A Case Report / 대한족부족관절학회지

In neurogenic equinovarus deformity, surgical intervention such as tendon transfer or osteotomy can be expected to improve symptoms. However, in rare cases of hereditary spastic paraplegia, the deformity and paralysis gradually progress. So limited operation and early post-operative rehabilitation are preferred to aggressive operation. We would like to report our clinical experience with one case of hereditary spastic paraplegia patient with reference review. A 40 year-old male, given tendon transfer of ankle and foot and tendo achilles lengthening 10 years ago, complained about aggravated spastic paraplegia which resulted in dynamic equinovarus and limited walking ability since his operation. Family history showed limited walking ability of his father with gradually progressing spastic paralysis and he was diagnosed as hereditary spastic paraplegia type I. We had performed a limited operation such as tendo achilles and tibialis posterior lengthening to induce plantigrade standing and walking with crutch. As a result, the patient was able to maintain a stabilized standing posture and walk after the operation. Hereditary spastic paraplegia presents with a progressive paralysis which limits rehabilitation after tendon transfer, and the symptoms can be aggravated. Therefore, considering potential hereditary neurogenic disorders in paients with equinovarus deformity and performing limited operative procedures seem to be important.