Use a leaflet flap of foot to severed multi-finger with segmental injury / 中国骨伤

OBJECTIVE@#To explore asurgical methods for replantation of severed finger.@*METHODS@#From January 2018 to November 2022, 8 amputated-finger patients were performed surgical reconstructions by using polyfoliate free flaps with the first dorsal metatarsal artery, including 7 males and 1 female, aged from 20 to 55 years old, and defect areas ranged from (1.0 to 2.0) cm×(3.0 to 4.5) cm. Finger pulp sensation, shape and other relevant parameters were assessed following the upper extremity functional evaluation standard, which was put forward by Hand Surgery Branch of Chinese Medical Association. And maryland foot functional score was used to evaluate foot function.@*RESULTS@#Amputated fingers and flaps of all the 8 patients were survived. All patients were followed up for 4 to 20 months, their finger color and temperature tured to normal, with good wear-resistance and cold-resistance. According to Hand Surgery Branch of Chinese Medical Association, functional score ranged 61 to 92;4 patients got excellent result and 4 good. Maryland foot functional score ranged from 93 to 100;and 8 patients got excellent result.@*CONCLUSION@#It is feasible to repair severed fingers with soft tissue defects using polyfoliate free flaps that driven by the flippers of the first and second toes of the foot. This method ccould bridge blood vessels, increase soft tissue volume of the injured finger, and avoid finger shortening, with high patient satisfaction.

Avaliação crítica das técnicas cirúrgicas de correção do equino / Critical evaluation of the surgical techniques to correct the equinus deformity

RESUMO A deformidade em equino leva a diversos transtornos da marcha, ao causar alterações no apoio do pé e afetar regiões anatômicas mais distantes, como o joelho, quadril e tronco. Geralmente é secundária à retração, encurtamento ou espasticidade do tríceps sural, de modo que algumas intervenções cirúrgicas podem ser necessárias para corrigi-la. Trata-se de um dos procedimentos mais antigos da Ortopedia, antes realizado apenas no tendão calcâneo e que, ao longo do tempo, evoluiu com técnicas diferentes de acordo com o grau de deformidade, doença de base e perfil do paciente. Busca-se corrigir a deformidade, com a menor interferência possível na força muscular e, com isso, diminuir a incidência de complicações, como marcha agachada, arrastada e pé calcâneo. Do ponto de vista anatômico, o tríceps sural apresenta cinco regiões que podem ser abordadas cirurgicamente para correção do equino. Em virtude da complexidade do paciente com equino, os ortopedistas devem ter experiência com ao menos uma técnica em cada zona. Neste texto são abordadas e analisadas criticamente as técnicas mais importantes para correção do equino, principalmente de modo a evitar complicações. Foi realizada uma busca sobre técnicas cirúrgicas mais comuns de correção do equino em livros clássicos e identificação e consulta aos artigos originais. Em seguida, fez-se uma busca em bases de dados nos últimos dez anos.

ABSTRACT The equinus deformity causes changes in the foot contact and may affect more proximal anatomical regions, such as the knee, hip and trunk, potentially leading to gait disorders. The equinus is usually secondary to retraction, shortening and/or spasticity of the triceps surae, and it may require surgical correction. Surgery for the correction of equinus is one of the oldest procedures in Orthopedics, and it was initially performed only at the calcaneus tendon. The technique has evolved, so that it could be customized for each patient, depending on the degree of deformity, the underlying disease, and patient´s profile. The aim is to correct the deformity, with minimal interference in muscle strength, thus reducing the incidence of disabling complications such as crouch gait and calcaneus foot. We conducted a literature search for the most common surgical techniques to correct the equinus deformity using classic books and original articles. Further, we performed a database search for articles published in the last ten years. From the anatomical perspective, the triceps surae presents five anatomical regions that can be approached surgically for the equinus correction. Due to the complexity of the equinus, orthopedic surgeons should be experienced with at least one procedure at each region. In this text, we critically approach and analyze the most important techniques for correction of the equinus, mainly to avoid complications.

Reconstrucción plantar con matriz de regeneración dérmica (Integra®) en paciente quemado eléctrico: presentación de un caso y revisión de la literatura / Plantar reconstruction with matrix of dermal regeneration (Integra®) in an electric burned patient: case report and literature review

Resumen Introducción: Las lesiones complejas de la cara plantar del pie son de difícil manejo desde el punto de vista reconstructivo. En la literatura el tratamiento de elección es la cobertura mediante colgajos libres. Nuestro objetivo es presentar el caso de un paciente con una lesión plantar compleja, exitosamente resuelta con el uso de matriz de regeneración dérmica (Integra®) e injerto dermoepidérmico. Caso clínico: Hombre de 35 años, que sufre quemadura eléctrica de alta tensión con lesión compleja plantar bilateral. Se manejó con escarectomías sucesivas hasta delimitar el daño tisular, y posterior cobertura con Integra® e injerto con resultado estético y funcional óptimo. Discusión: Aunque los colgajos libres son la elección en el tratamiento de esta zona anatómica, infrecuentemente son la única alternativa de reconstrucción en el paciente quemado. No hay mayor evidencia en la literatura en el uso de matrices dérmicas para la cobertura de este tipo de lesiones. Conclusión: Los autores consideran que el manejo de lesiones plantares complejas mediante el uso de matrices de regeneración dérmica es una alternativa válida a considerar en situaciones en que, por diversos motivos, no se puede ofrecer un colgajo libre.

Abstract Introduction: Complex wounds of the plantar aspect of the foot are difficult to manage in the reconstructive point of view. The standard of treatment is covering the defect with free flaps. Our goal is to present the case of a patient successfully treated with the use of matrix dermal regenaration Integra® and dermoepidermal graft for a complex plantar lesion. Clinical case: Thirty-five year old man, who suffers from high voltage electrical burn with bilateral plantar complex injury. It was handled with successive escharectomies to delimit tissue damage and subsequent coverage with Integra® and grafting with optimal aesthetic and functional results. Discussion: Although free flaps are the choice in the treatment of this anatomical area, they are infrequently the only reconstructive option in burned patients. There is no greater evidence in the literature on the use of dermal matrices to cover such injuries. Conclusion: The authors believe that the management of complex footpad lesions using dermal regeneration matrices are a valid alternative to consider in situations where for various reasons, free flaps can't be offered.

Reconstrucción con injerto autólogo no vascularizado de peroné posterior a resección de quiste óseo simple en segundo metatarsiano: a propósito de un caso / Reconstruction with non-vascularized autologous fibula graft after resection of simple bone cyst in the second metatarsal: a case report

El quiste óseo simple es una patología pseudotumoral características de las dos primeras décadas de la vida, localizada principalmente en húmero o fémur. La localización metatarsiana es considerada rara. El peroné puede ser utilizado para reconstrucción de defectos óseos. Se realizó estudio observacional, descriptivo, en el Hospital Dr. Adolfo Pons de Maracaibo, Edo Zulia, Venezuela, donde presentamos paciente femenino de 12 años de edad, en quien se reconstruyó defecto óseo metatarsiano producto de resección de quiste simple, mediante injerto no vascularizado de peroné. Se obtuvo consolidación e integración total de injerto con resultado funcional excelente(AU)

Simple bone cyst is a pseudotumoral condition that when coming up, it usually occurs during the first two decades of life, mainly located in the humerus or femur. The metatarsal location is considered rare. The fibula can be used for bone defects reconstruction. An observational and descriptive study was conducted at Dr. Adolfo Pons Hospital, in which we present a 12 years old patient who underwent a second metatarsal bone defect reconstruction with a non-vascularized fibular graft after resection of a simple cyst. Graft consolidation and total integration were obtained with excellent functional outcome(AU)

Ectrodactilia del pie. Reporte de dos casos / Ectrodactyly of the foot

Antecedentes: La ectrodactilia es una malformación congénita caracterizada por la presencia de hendiduras en los pies acompañada de agenesia e hipoplasia de los metatarsianos y falanges. Es un desorden genético muy poco frecuente, con una incidencia de 1:90,000-100,000 nacimientos vivos y no está ligada al sexo. Su patrón genético es de tipo autosómico dominante con penetrancia genética variable. El diagnóstico es clínico al momento del nacimiento; sin embargo, puede ser prenatal mediante ultrasonografía desde el primer trimestre de gestación. El manejo de la ectrodactilia incluye tanto el tratamiento quirúrgico como el no quirúrgico. Métodos: Se revisó el archivo de historias médicas desde enero 2005 a enero 2010, se incluyeron todos los pacientes con diagnóstico de ectrodactilia. Se encontraron dos pacientes que fueron tratados quirúrgicamente a los cuales se les realizó un seguimiento mínimo de tres años. Resultados: La evolución a largo plazo fue favorable permitiendo el uso de calzado y la marcha. No se evidenciaron recidivas o complicaciones. Los resultados finales fueron buenos de acuerdo a la escala de Tani y colaboradores. Discusión: De acuerdo a nuestros resultados a mediano y largo plazo en el manejo de estos dos casos de ectrodactilia, recomendamos la combinación del tratamiento ortopédico conservador, como preparación para la cirugía, y la resolución definitiva mediante cierre de la hendidura. El tratamiento quirúrgico realizado y el adecuado manejo postoperatorio permitieron el uso de calzado, mejorar la función y apariencia en ambos casos.

Background: Ectrodactyly is a congenital malformation characterized by the presence of clefts in the feet accompanied by aplasia and hypoplasia of the phalanges and metatarsals. It is a rare genetic disorder with an incidence of 1:90,000-100,000 live births and it is not linked to sex. Its genetic pattern is autosomal dominant with a variable genetic penetrance. Clinical diagnosis is made at birth, however it can be prenatal through ultrasound during the first trimester. Management of ectrodactyly includes both surgical and non-surgical treatment. Methods: We reviewed the archive of medical histories from January 2005 to January 2010, we included all patients with an ectrodactyly diagnosis. We found two patients who were treated surgically and were followed-up for three years. Results: The long term evolution was favorable, allowing the patient to wear shoes and walk. There were no recurrences or complications observed. The final results were good according to the Tani et al scale. Discussion: According to our medium and long term results in the management of these two cases of ectrodactyly, we recommend the combination of conservative orthopedic treatment as preparation for surgery and the final resolution with closure of the cleft. The surgical treatment performed and appropriate postoperative management allowed the patient to wear shoes, to improve function and appearance in both cases.

Use of lopinavi//ritonavir associated with ergoamine resulting in foot amputattion: brief communicatoon / Uso de lopinavir/ritonavir associado com ergotamina resultando em amputação de pé: comunicação breve

A 32-year-old female, was diagnosed in 2004 with a C1 HIV1 infection, using zidovudine/lamivudine 300/150 mg BID and lopinavir/ritonavir 400/100 mg BID, in addition to prophylaxis with trimethoprim-sulfamethoxazole 800/160 mg QD, but no prophylaxis with macrolide antibiotics. The patient presented with a severe headache and was prescribed two capsules of the anti-migraine drug Ormigrein™, which contained ergotamine tartrate 1 mg, caffeine 100 mg, paracetamol 220 mg, hyoscyamine sulfate 87.5 mcg, and atropine sulfate 12.5 mcg. Afterwards she was prescribed one capsule of Ormigrein every 30 minutes for a total of six capsules a day. The patient took the medication as prescribed but developed a pain in her left ankle three days later, which evolved to the need for amputation.

Mulher de 32 anos infectada pelo HIV 1, vinha utilizando zidovudina/lamivudina 300/150 mg um comprimido duas vezes ao dia e lopinavir/ritonavir 200/50 mg dois comprimidos duas vezes ao dia e profilaxia com sulfametoxazol-trimetoprim 800/160 mg uma vez ao dia, sem profilaxia com macrolídeos. A paciente apresentou enxaqueca severa com prescrição da associação tartarato de ergotamina 1 mg, cafeína 100 mg, paracetamol 220 mg, sulfato de hiosciamina 87,5 mcg, sulfato de atropina 12,5 mcg, dois comprimidos na crise, seguido de um comprimido a cada 30 minutos, com no máximo seis comprimidos ao dia. A paciente ingeriu seis comprimidos em um dia, surgindo uma dor em tornozelo esquerdo três dias depois, que evoluiu para ergotismo e amputação do pé.

A rare anomaly of the foot presented as polydactyly.

Presence of one or more digit is called as polydactyly and may manifest singly or with other genetic disorders. The frequency of polydactyly varies widely among populations. It can occur as an isolated condition or as a feature of a congenital condition. Polydactyly is a rare condition, but still rare is in form of triple great toes. We describe a case in a 4‑year‑old child diagnosed as triphalangism foot with no other obvious visible anomaly. Osteoplasty‑combined surgery, which was ideal for anatomical reconstruction. In a 16‑month follow‑up period child recovered very well.

Treatment Outcomes of Advanced Stage Malignant Melanoma in Hand and Foot after Amputation in Korean Patients

BACKGROUND: A retrospective study was conducted to review the overall survival and treatment outcomes of high grade melanoma in the extremity to explore the clinical features of malignant melanoma of the hand and foot, and the therapeutic efficacies and survival rate after amputation. METHODS: The clinical data of 30 patients with malignant melanoma of the hand and foot (confirmed by pathological examination), who were admitted and treated in our hospital between 2001 and 2010, were analyzed retrospectively. We analyzed variables affecting overall and disease-free survival. RESULTS: Thirty patients (18 men and 12 women) treated with an amputation procedure for malignant melanoma in the hand or foot constituted the study cohort. The average age of the patients at the time of diagnosis was 58.7 years. Univariate analysis for overall melanoma survival revealed that diagnosis at over 70 years of age, postoperative lymph node metastasis, and location of the tumor were significant prognostic factors. And on the Kaplan-Meier survival curve, old age, American Joint Committee on Cancer stage and postoperative lymph node metastasis showed statistically significant differences in the 5-year survival rate. Also, amputation with aggressive lymph node dissection showed improved long term survival in advanced stage melanoma. CONCLUSIONS: In Korean melanoma patients, for the treatment of high grade melanomas in the extremities after amputation, early diagnosis and postoperative follow-up for evaluation of lymph node metastasis are critical factors for long-term survival. And by performing lymph node dissection during amputation, we may improve the survival rate in advanced stage melanoma patients.

Colgajo sural de flujo reverso, a propósito de un caso / Sural artery perforator flap of reverse flow, apropos of a case

La reconstrucción del pie y pierna representa un desafío para el cirujano. Se presenta el caso clínico de un paciente de 32 años con una úlcera maleolar externa en el tobillo izquierdo que se trató con un colgajo sural de flujo reverso. Describimos el tratamiento realizado, detallando la técnica quirúrgica. Posteriormente comentamos algunos conceptos relevantes que encontramos al realizar una revisión de la literatura. Se comentan las indicaciones, detalles de la técnica quirúrgica y las complicaciones de esta cirugía.

The reconstruction of the foot and leg are a challenge for surgeons. We present a clinical case of a 32 years patient with an external malleolar ulcer in his left ankle. We treated it with a distally based sural flap. In this article we describe the treatment done, detailing the surgical technique. Thereafter, we describe some relevant concepts founded in the literature. We describe the indications, details of the surgical technique and complications of this surgery.

Ethnic and health correlates of diabetes-related amputations at the Texas-Mexico border / Correlatos étnicos y de salud de las amputaciones relacionadas con la diabetes en la frontera entre Texas y México

OBJECTIVE: To examine the association between diabetes-related lower-extremity amputation (LEA) and ethnicity, age, source of payment, geographic location, diabetes severity, and health condition in adults with diabetes mellitus type 2 living in border and non-border counties in Texas, United States of America, and to assess intra-border region geographic differences in post-LEA treatment. METHODS: This correlational study was based on secondary data from the 2003 Texas Inpatient Hospital Discharge Data. The sample consisted of individuals 45 years of age and older with type 2 diabetes who had undergone a nontraumatic LEA (n = 5 865). Descriptive statistics and logistic regression analyses were applied. RESULTS: The following characteristics were predictors of LEA: being Hispanic or African American, male, > 55 years old, and a Medicare or Medicaid user, and living in a border county. Persons with moderate diabetes and those who suffered from cardiovascular disease or stroke also had higher odds of undergoing an LEA. Post-LEA occupational therapy was significantly less prevalent among border residents (9.5 percent) than non-border residents (15.3 percent) (P < 0.001). CONCLUSION: Understanding the factors that influence diabetes-related LEA may lead to early detection and effective treatment of this disabling consequence of diabetes along the U.S.-Mexico border.

OBJETIVO: Analizar la asociación entre las amputaciones de extremidades inferiores (AEI) relacionadas con la diabetes y el grupo étnico, la edad, la procedencia del pago, la ubicación geográfica, la gravedad de la diabetes y el estado de salud de los adultos que padecen diabetes tipo 2 residentes en los condados fronterizos y no fronterizos de Texas (Estados Unidos de América), y evaluar la diferencias geográficas dentro de la zona fronteriza en cuanto al tratamiento posterior a la amputación. MÉTODOS: Este estudio correlacional se basó en datos secundarios procedentes de la información de egreso de pacientes hospitalizados en Texas durante el año 2003. La muestra estuvo integrada por personas de 45 años o mayores con diabetes tipo 2, que habían sido sometidas a la amputación no traumática de una extremidad inferior (n = 5 865). Se aplicaron estadística descriptiva y análisis de regresión logística. RESULTADOS: Las siguientes características constituyeron factores predictivos de AEI: ser hispano o afroestadounidense, hombre, de 55 años o mayor, beneficiario de Medicare o Medicaid, y residente en un condado fronterizo. Las personas con diabetes moderada que padecían enfermedades cardiovasculares o habían sufrido un accidente cerebrovascular también tenían una mayor probabilidad de ser sometidas a una AEI. La terapia ocupacional posterior a la amputación fue significativamente menos prevalente entre los residentes fronterizos (9,5 por ciento) que entre los no fronterizos (15,3 por ciento) (P < 0,001). CONCLUSIONES: La comprensión de los factores que influyen en las AEI relacionadas con la diabetes puede conducir a la detección temprana y el tratamiento eficaz de esta secuela discapacitante en la zona fronteriza entre los Estados Unidos y México.

Clubfoot management by the Ponseti technique in Saudi patients

To assess the effectiveness of the Ponseti technique in the treatment of clubfoot in Saudi children. The data of 175 patients [235 feet], who presented with clubfeet from September 2002 to June 2008 and who were treated with the Ponseti technique at King Abdulaziz Medical City in Riyadh, Kingdom 0f Saudi Arabia were collected and studied retrospectively. The Pirani score for clubfoot evaluation was used in this study. Age ranged from one week to 48 weeks, with an average age of 6.5 weeks. The average follow up was 37 months [range one year to 6 years and 7 months]. The average time to obtain correction was 5.3 weeks [range 4-10 weeks]. Six patients [8 feet] [3.4%] were not corrected with initial casting and required early surgery. Full correction was obtained in 169 patients [227 feet] [96.6%]. Tenotomies were performed in all but one patient [2 feet] [0.9%]. Thirty-four patients [48 feet] [21.1%] relapsed. One hundred and seventy-nine feet [78.9%] required no further treatment, and only 4 feet [1.8%] required a more extensive posterior-medial release. Minor complications were noted in 14 patients [18 feet] [7.9%]. The Ponseti technique is a safe and effective conservative treatment of clubfoot that decreases the number of surgical interventions needed for the correction of the deformation in our Saudi patients. It is an easy method to understand and to apply by most orthopedic surgeons

Soft Tissue Reconstruction of the Foot Using the Distally Based Island Pedicle Flap after Resection of Malignant Melanoma

BACKGROUND: We report on our experience with using a distally based island flap for soft tissue reconstruction of the foot in limb salvage surgery for malignant melanoma patients. METHODS: A distally based sural flap was used for 10 cases for the hindfoot reconstruction, and a lateral supramalleolar flap was used for 3 cases for the lateral arch reconstruction of the mid- and forefoot after wide excision of malignant melanomas. RESULTS: The length of the flap varied from 7.5 cm to 12 cm (mean, 9.6 cm) and the width varied from 6.5 cm to 12 cm (mean, 8.8 cm). Superficial necrosis developed in four flaps, but this was successfully treated by debridement and suture or a skin graft. All thirteen flaps survived completely and they provided good contour, stable and durable coverage for normal weight bearing. CONCLUSIONS: The distally based sural flap is considered to be useful for reconstructing the hindfoot, and the lateral supramalleolar flap is good for reconstructing the lateral archs of the mid- and forefoot after resection of malignant melanoma of the foot.

Un nuevo abordaje medial para el bloqueo del nervio ciático a nivel del hueco poplíteo con bupivacaína 0.375 por ciento. Experiencia clínica / A new medial approach to block the sciatic nerve at the level of the popliteal space with 0.375 per cent bupivacaine. Clinical experience

Introducción: El bloqueo del nervio ciático a nivel poplíteo, ya sea por vía lateral o posterior, fue descrito por varios autores. La imposibilidad de colocar a algunos pacientes en decúbito ventral para el abordaje posterior nos llevó a estudiar este abordaje medial del nervio ciático para bloqueo analgésico en cirugía de tobillo y pie. Objetivo: Evaluar la utilidad y eficacia de un nuevo abordaje del nervio ciático en el hueco poplíteo siguiendo un protocolo de analgesia posoperatoria en cirugía de tobillo y pie. Material y métodos: 40 pacientes ASA I-II programados para cirugías de tobillo y pie. Se realizó el bloqueo del nervio ciático como técnica analgésica a nivel del hueco poplíteo por vía medial. Utilizando la técnica de neuroestimulación, se inyectaron 30 ml de bupivacaína 0,375 por ciento como dosis única. Como técnica anestésica se realizó un bloqueo subaracnoideo en la misma posición. Fueron evaluados en el intraoperatorio: tiempo para realizar el bloqueo, distancia piel nervio, respuesta obtenida, punciones vasculares y contactos óseos. Luego, en el posoperatorio, se midió el grado de analgesia por escala visual análoga (EVA), necesidad de rescates, duración del bloqueo y grado de satisfacción. Resultados: El tiempo promedio para realizar el bloqueo fue de 2,55 min, y la distancia promedio piel-nervio fue de 66 ± 5 mm. En 12 (30 por ciento) pacientes la primera respuesta obtenida fue de ciático poplíteo externo, y en 28 (70 por ciento) de ciático poplíteo interno. Observamos 2 punciones vasculares y una ósea. El promedio de duración del bloqueo fue de 15,54 horas. El dolor por EVA a las 4, 8, 12 y 24 horas fue de 0,38, 0,58, 2 y 3,55, respectivamente. En 6 pacientes se requirió rescate analgésico. Discusión: En nuestra experiencia, el abordaje medial fue fácil de realizar y de gran utilidad para el manejo de la analgesia posoperatoria en cirugías de tobillo y pie, especialmente en pacientes con dificultades para posicionarse en decúbito ventral.

Introduction: The block of the sciatic nerve at the level of the popliteal space, be it by lateral or posterior approach, has been described by several authors. The impossibility of placing some patients face down for posterior approach led us to study this medial approach of the sciatic nerve for analgesic blockage in ankle and foot surgery. Objective: To evaluate the usefulness and efficiency of a new approach to the sciatic nerve in the popliteal space following a protocol of postoperative ankle and foot surgery analgesia. Material and methods: 40 ASA I-II patients programmed for ankle and foot surgery. Block of sciatic nerve was carried out as an analgesic technique at the level of the popliteal space through a medial route. Using the neurostimulation technique, 30 ml of 0,375 per cent bupivacaine was injected as a single dose. The anesthesia technique was the subaracnoid block in the same position. During the operation, the following data was evaluated: time taken for blocking, skin-nerve distance, response obtained, vascular punctures and bone contacts. Degree of analgesia by analogue visual scale (EVA), need for rescue, duration of blockage and degree of satisfaction were measured during the postoperative period. Results: The average time for blockage was 2,55 min and the average skin-nerve distance was 66 ± 5 mm. In 12 (30 per cent) patients the first response obtained was of external popliteal sciatic and in (70 per cent), of internal popliteal sciatic. We observed 2 vascular and one bone punctures. The average duration of the block was 15,54 hours. Pain by analogue visual scale at 4, 8, 12 and 24 hours was 0,38, 0,58, 2 and 3,55, respectively. Six patients required analgesic rescue. Discussion: In our experience, the medial approach was easy to carry out and very useful for managing postoperative analgesia in ankle and foot surgery, particularly in patients who had difficulties in lying on their stomach

Introdução: O bloqueio do nervo ciático a nível poplíteo, seja por via lateral ou posterior, foi descrito por vários autores. A impossibilidade de colocar alguns pacientes na posição decúbito ventral para a abordagem posterior nos levou a estudar esta abordagem medial do nervo ciático para o bloqueio analgésico em cirurgia de calcanhar e pé. Objetivo: Avaliar a utilidade e eficácia de uma nova abordagem do nervo ciático no oco poplíteo seguindo um protocolo de analgesia pósoperatória em cirurgia de calcanhar e pé. Material e métodos: Estudaram-se 40 pacientes ASA I-II programados para cirurgias de calcanhar e pé. Foi feito o bloqueio do nervo ciático como técnica analgésica na altura do escavado poplíteo por via medial. Utilizando a técnica de neuroestimulacão, injetou-se uma dose única de 30 ml de bupivacaína 0,375 por cento. Na mesma posição, foi realizado um bloqueio subaracnóideo como técnica anestésica. No intraoperatório foram avaliados: tempo para realizar o bloqueio, distancia pele-nervo, resposta obtida, punçõs vasculares e contatos ósseos; e no pós-operatório, o grau de analgesia empregando a escala visual análoga (EVA), a necessidade de resgates, a duração do bloqueio e o grau de satisfação. Resultados: O tempo médio para realizar o bloqueio foi de 2,55 min, e a distancia média pele-nervo foi 66 ± 5 mm. Em 12 (30 por cento) pacientes a primeira resposta obtida correspondeu ao ciático poplíteo externo, e em 28 (70 por cento) ao ciático popliteo interno. Houve duas punções vasculares e uma óssea. A duração média do bloqueio foi de 15,54 horas. A dor por EVA as 4, 8, 12 e 24 horas foi de 0,38, 0,58,2 e 3,55, respectivamente. Seis pacientes precisaram analgesia de resgate. Discussão: Em nossa experiencia, a abordagem medial foi fácil de realizar e de grande utilidade para o controle da analgesia pós-operatória em cirurgias de calcanhar e pé, especialmente em pacientes com dificuldades para se posicionar em decúbito ventral.

Colgajo libre osteomuscular para la reconstrucción del pie / Free flaps on foot reconstruction

Se presenta el caso clínico de una lesión grave en dorso de pie por accidente de tránsito con compromiso óseo, tendinoso y cutáneo. Se planeó y realizó un colgajo libre osteomuscular de músculo serrato anterior con segmentos de costilla vascularizados, con adecuada evolución e integración y buena rehabilitación del paciente en cuanto a marcha, bipedestación y colocación de calzado.

Comparison of modified posteromedial release and complete subtalar release in resistant congenital clubfoot: a randomized controlled trial.

OBJECTIVE: To compare the surgical results of modified posteromedial release with modified complete subtalar release in resistant congenital clubfoot in a randomized controlled trial MATERIAL AND METHOD: Eighty six children with 128 clubfeet, at an average of 5.9 months old (3-12 months) were operated on between 1996 and 2006 by a single surgeon. They were randomized into two groups. Group A, the modified posteromedial release was performed on 47 children with 69 clubfeet from 26 boys and 21 girls. Group B, the modified complete subtalar release was performed on 39 children with 59 clubfeet from 22 boys and 17 girls. Both groups received the same postoperative protocols. The mean follow up time was 15.1 months in group A (3-90 months) and 23.7 months in group B (3-120 months). RESULTS: There were no statistically significant differences of both groups between age, sex, side, bilaterality, and Dimeglio pre-operative evaluation. Most of the children ended up with satisfactory appearance of feet without major complications, neurovascular injuries, talonavicular dislocation, or avascular necrosis of the talus. Mild forefeet adduction was found in 10 feet in group A and in 5 feet in group B but allfeet were flexible and reducible to normal alignment of the feet. Two feet in group A and one foot in group B were re-operated by soft tissue release without bone surgery and had fair results. Four feet in group A and two feet in group B got soft tissue infection and resolved in a few weeks by dressing and antibiotics. The postoperative mean Ponseti score was 89.6 (75-100) points in group A and 88.2 (70-98) points in group B without statistically significant difference (p = 0.25). The Turco postoperative evaluation of both groups was not statistically significantly different (p = 0.17). The good and excellent results from Ponseti score was 85.5% in group A and 89.9% in group B. The correlation coefficient (r) between Ponseti and Turco evaluation was 0.81. CONCLUSION: The clinical and statistical significant difference were not found in the surgical results of modified posteromedial release and modified complete subtalar release in resistant clubfeet.

Distally based sural neurocutaneous flap for ankle and foot reconstruction

To evaluate role of sural neurocutaneous flap for reconstruction of ankle and foot in our set up. Department of Plastic Surgery, Pakistan Institute of Medical Sciences, Islamabad. From January 1997 to August 2004. We conducted a prospective study to evaluate the role of distally based sural neurocutaneous flap for soft tissue reconstruction of the ankle and foot. A total of 33 patients with soft tissue defects of the ankle and foot were managed by this flap. Mean age of the patients was 31.8 years with range 10-70 years, 30 males and 3 female were included in the study. Most common cause of the defect was trauma and heel was the most common location. Mean flap length was 18.4 cm and mean width 6.2 cm. Range of flap dimensions was 12 x 4 cm. to 28 x 8 cm. Minor complications occurred in three cases. These included partial flap necrosis, wound dehiscence and flap oedema. We conclude that distally based sural neurocutaneous flap is a very effective tool for reconstructing the soft tissue defects in the difficult ankle and foot region