Ultrasonic debridement management of lower extremity wounds: retrospective analysis of clinical outcomes and cost.

OBJECTIVE: The aim of this study was to assess wound healing outcomes following direct, low-frequency, high-intensity, ultrasonic debridement as a surgical adjunct for non-healing lower extremity wounds. METHODS: A retrospective review was conducted for patients undergoing lower extremity wound treatment with direct, low-frequency (22.5 kHz), high-intensity (~60 W/cm2) ultrasonic debridement between January 2010 and January 2016. Clinical outcomes were assessed up to 180-days post-ultrasonic debridement. Descriptive statistics, cost and univariate analysis were performed. RESULTS: Overall, 82 wounds in 51 patients were included. Mean age was 57.0 years (range: 32-69), and average body mass index (BMI) was 30.8 kg/m². Patient comorbidities consisted of smoking (47%; n=24), hypertension (75%; n=38), diabetes (45%; n=23), and peripheral vascular disease (51%, n=26). Average wound age at initial presentation was 1013 days (range: 2-5475 days) with an average wound size of 9.0cm x 7.4cm. At 180-days post-debridement, 60% (n=49) of wounds had completely healed. Readmission (47%; n=24) and reoperation (45%; n=23) rates were characterised by the reason for readmission and reoperation respectively. Readmission for wound healing (70%, n=39) was primarily for further debridements (41%; n=16). Wound infection (30%; n=7) was the most common readmission for wound complications (30%; n=17). Reoperations primarily consisted of treatments for further wound healing 96% (n=51). Cost analysis showed a lower total treatment cost for patients with improved healing ($78,698), compared with non-improved wounds ($137,707). CONCLUSION: In a complex, heterogeneous cohort of chronic extremity wounds, the use of direct, low-frequency, high-intensity, ultrasonic debridement is a safe and reliable adjunctive therapy for the management of these wounds.

Ankle distraction arthroplasty combined with joint resurfacing for management of an osteochondral defect of the talus and concomitant osteoarthritis: a case report.

There are many treatment options for patients with ankle osteochondral defects and subsequent osteoarthritis. Although ankle arthrodesis remains the gold standard to definitive treatment of this condition, its permanent sequelae demands an alternative. In this article we discuss a case report from a 61-year-old woman with a history of a previous ankle sprain resulting in an osteochondral defect that progressed to develop ankle osteoarthritis. After multiple attempts at conservative management, the patient underwent placement of an articulating external ring fixator for arthrodiastasis, as well as ankle joint resurfacing using allograft. The fixator was kept in place for a total of 12 weeks, with the patient performing range-of-motion exercises throughout the treatment course. We feel that this treatment presents as a promising treatment alternative based on the success demonstrated by this patient's 6-month follow-up. The patient has reported a decease in ankle joint pain, increased range of motion, and a return to normal daily activity without limitation.

Master techniques in digital arthrodesis.

This is a comprehensive review of various techniques of digital fusion. Evolution of the technique has afforded today's surgeons a valuable repertoire of surgical options. Ultimately, patient factors and surgeon preference determine the most appropriate method of fixation.

Triple arthrodesis.

A triple arthrodesis is a fusion of the talocalcaneal, calcaneal cuboid, and talonavicular joints. The purpose is to create a well-aligned, plantigrade, and stable foot for patients with deformity or progressive neurologic and arthritic conditions. This article is a comprehensive overview of the procedure. However effective, triple arthrodesis is a challenging procedure for even the most skilled surgeon.