ABSTRACT
Bone grafting is commonly used in reconstructive foot and ankle surgery. The calcaneus provides an excellent site for graft harvest due to its rich vascularity and access to corticocancellous or strictly cancellous bone. The relatively thin soft tissue envelope makes dissection easy compared to more proximal autograft sites. In this investigation we quantified cancellous autograft volume from the calcaneus while simultaneously defining anatomical safe zones and identifying anatomical structures at risk. Nine matched-pair (18 total) fresh-frozen cadaveric below-knee limbs were utilized. All limbs were thawed at room temperature prior to the procedure. Calcaneal autograft was harvested following the senior author's (D.J.E.) technique. Bone graft was packed and quantified by podiatric medical students (B.R. and J.T.). An independent investigator (K.S.) meticulously dissected the lateral calcaneal soft tissue envelope to determine rates of neurovascular compromise. Anatomical safe zones were defined by measurements of the harvest site compared to vital anatomical structures. Cancellous autograft averaging 0.85 cc was obtained through an average cortical opening of 0.77 cm. The stab incision is approximately 2.2 cm anterior to the posterior aspect of the calcaneus and 1.6 cm superior to the inferior aspect of the calcaneus. This incision is an average 1.8 cm from the main branch of the sural nerve. No neurovascular damage was found. This study details percutaneous harvest of calcaneal autograft for use in forefoot or midfoot surgeries with an emphasis on feasibility of this additional procedure. The technique proposed is valuable based on simplicity, wide anatomic safe zone, and potential improvement of surgical outcomes.
Subject(s)
Calcaneus , Autografts , Bone Transplantation , Cadaver , Calcaneus/surgery , Humans , Sural Nerve/anatomy & histologyABSTRACT
Surgical treatment of the elderly can be a very difficult and complex endeavor. Appropriate and thorough evaluation of this group of patients is essential to identify surgical candidates who may be at increased risk for developing age-related problems, such as cognitive impairment or postoperative delirium. Involvement of family members and ancillary caregivers is ideal. In order to optimize surgical results, communication of goals of surgery and expectations of patients in order to achieve these goals is paramount. Physical therapy assessment of the elderly will give input on patients' capacity to perform needed changes in ambulatory status after surgery.
Subject(s)
Cognition Disorders/physiopathology , Delirium/therapy , Orthopedic Procedures/adverse effects , Postoperative Complications/prevention & control , Preoperative Care/methods , Accidental Falls/prevention & control , Aged , Cognition Disorders/therapy , Delirium/etiology , Female , Follow-Up Studies , Geriatric Assessment , Humans , Male , Orthopedic Procedures/methods , Patient Care Team/organization & administration , Perioperative Care/methods , Podiatry/methods , Risk Assessment , Treatment Outcome , Vulnerable PopulationsABSTRACT
Treating patients with kidney disease can be both a difficult and a complex process. Understanding how to care for patients who have kidney disease is essential for lowering perioperative as well as periprocedural morbidity and mortality. The primary aim in renal evaluation and care is to control and mitigate factors that may result in acute kidney injury (AKI) and/or cause further decline in renal function. It is essential for the foot and ankle specialist to recognize patients who are predisposed to developing or already have impairment of renal function.
