RESUMEN
Background: A tarsal coalition is a bridging of two or more of the bones in the hindfoot. Multiple coalitions aredescribed in the literature. However, the presence of a tibio-talar coalition has not previously been reported.Results : Here, we describe the first reported case of tibio-talar and fibulo-talar coalition in the literature in a 31-year-old male. The patient had a 5-year history of bilateral hindfoot and ankle pain, with an established rightsided talo-calaneal coalition. Investigations and subsequent open chilectomy and debridement surgery confirmeda tibio-talar and fibulo-talar coalition. The patient was discharged at one-year following surgery as he was painfree and returned to work.Conclusions: We report the first case of failure of mesenchymal segmentation leading to tibio-talar fibrouscoalition and fibulo-talar coalition. In this case surgical debridement provided resolution of symptoms. Level ofClinical Evidence: 4
RESUMEN
Background: Revascularization alternatives for patients with critical limb ischemia and with- out adequate autogenous vein remain challenging. We reviewed our experience with the use of arterial homo- graft as a conduit for limb salvage in patients with limb ischemia and active lower extremity infections
Methods: A retrospective review of patients who underwent open arterial revascularization of the lower extremity with cryopreserved femoral artery homo- graft for the treatment of symptomatic critical limb ischemia [i.e., foot ulceration, infection, or gangrene] during an 18-month period was performed. Relevant clinical variables and treatment outcomes were analyzed. Clinical success was defined as limb salvage for one year, patency of the reconstruction, and wound healing
Results: Thirteen patients [5 men; average age 71 +/-8.3 years, range 51-87 years] were treated during this study period. Treatment indications included 10 [77%] foot ulcerations, 2 [15%] critically ischemic limbs with- out ulceration, and 1 [8%] infected polytetrafluoro- ethylene bypass graft with acute occlusion and limb ischemia. A femoral below-the-knee popliteal bypass was performed in 4 [1%], femoral to anterior tibial artery in 4 [31%], femoral to posterior tibial artery in 3 [23%], and femoral to peroneal artery in 2 [15%]. All 13 limbs were preserved. Minor amputations were performed in 6 patients, 2 underwent toe amputations and 4 patients had a trans-metatarsal amputation. The cumulative patency rate at 6, 9, and 18 months was 92.3%, 70.3%, and 58.6%, respectively
Conclusion: Open arterial revascularization with arterial femoral homograft is an acceptable treatment method in patients with critical limb ischemia and active infection in whom autogenous vein is not available or the use of a synthetic conduit is not possible