ABSTRACT
The sural flap procedure is a versatile technique that can be used to cover many types of defects about the lower extremity. The management of soft tissue defects of the lower extremity with underlying osteomyelitis is difficult. The goal for any of these patients is to create a biomechanically stable foot for weight-bearing purposes with no continued infection. Data were gathered using multiple databases from the years 2000 to 2016. Data were compiled looking at the number of subjects, age, comorbidities, number of complications, number of failures, and average flap size of complications/failures. A total of 110 patients were gathered using 5 separate articles. Twenty-two of the 110 patients had short-term complications. Flap failure was seen in 9/110 patients. A significant difference was noticed in flap size between flap failure and complication groups and nonfailure groups. The average flap size of patients who had some form of complication or failure was 51.87 cm2 in size. The average graft size for patients without complications during their recovery was 36.54 cm2. Within our study, the failure rate of 8.9% and complication rate of 13.7% are consistent with previous reports on sural perforator flaps. Last, with regard to the effect of flap size, there were significant differences between patients with a successful outcome and those who experienced complications or failures. LEVELS OF EVIDENCE: Therapeutic, Level III: Systematic review.
Subject(s)
Leg Injuries/surgery , Myocutaneous Flap/transplantation , Osteomyelitis/surgery , Plastic Surgery Procedures/methods , Soft Tissue Injuries/surgery , Female , Foot Injuries/diagnosis , Foot Injuries/surgery , Graft Rejection , Graft Survival , Humans , Injury Severity Score , Leg Injuries/diagnosis , Male , Myocutaneous Flap/blood supply , Osteomyelitis/diagnosis , Predictive Value of Tests , Soft Tissue Injuries/diagnosis , Treatment Outcome , Wound Healing/physiologyABSTRACT
Obesity has been posited as a predictor for the development of Charcot neuroarthropathy, a severe form of degenerative joint disease associated with peripheral neuropathy and diabetes mellitus. The present case-control study investigated the relationship between elevated (overweight and obese) body mass index and acute Charcot neuroarthropathy in a diabetic population. The final data set consisted of 49 patients, 20 (40.82%) of whom had Charcot foot and 29 (59.18%) who served as controls. In the present investigation, no statistically significant association was found between an elevated body mass index and the development of acute Charcot neuroarthropathy involving the foot.
Subject(s)
Body Mass Index , Diabetic Neuropathies/complications , Foot Diseases/physiopathology , Peripheral Nervous System Diseases/physiopathology , Acute Disease , Arthropathy, Neurogenic/physiopathology , Female , Humans , Male , Middle AgedABSTRACT
Open ankle fractures with dislocation are potentially limb-threatening injuries with complications ranging from infection to amputation. External fixation has been used in trauma institutions for limb salvage, particularly in the setting of extensive soft tissue compromise. The authors present a case of an elderly woman with an open ankle fracture dislocation who underwent a staged surgical approach. A LIMA external fixator was used in conjunction with antibiotic beads and subsequent definitive open reduction with internal fixation. At 5-year follow-up, the patient demonstrated pain-free range of motion with a return to activity comparable to the preinjury state. The authors highlight the benefit of procedure staging in the presence of a severe fracture dislocation of the tibiotalar joint.
Subject(s)
Ankle Injuries/therapy , External Fixators , Fracture Fixation, Internal , Fractures, Open/therapy , Joint Dislocations/therapy , Limb Salvage/methods , Aged, 80 and over , Anti-Bacterial Agents/administration & dosage , Female , Humans , Tobramycin/administration & dosageABSTRACT
Ankle fractures have been widely described in orthopedic and podiatric studies. These injuries have been associated with significant patient morbidity, infection, malunion, nonunion, and arthritis. Avoiding complications and optimizing outcomes demands an awareness of the factors affecting the healing of ankle fractures. The prognosis of surgical treatment of these injuries has varied according to patient factors or injury severity, or a combination. Cigarette smoking, obesity, and diabetes are some of the factors linked to the prognosis of ankle fractures. We conducted a retrospective cohort study of 58 patients treated for an ankle fracture at a single center. The objective of the present study was to comprehensively evaluate the factors affecting the clinical outcome of surgically treated ankle fractures.
Subject(s)
Ankle Injuries/physiopathology , Fracture Healing/physiology , Ankle Injuries/surgery , Cohort Studies , Female , Humans , Male , Middle Aged , Obesity/complications , Peripheral Nervous System Diseases/complications , Prognosis , Retrospective Studies , Smoking/adverse effectsABSTRACT
Management of a dislocated ankle fracture can be challenging because of instability of the ankle mortise, a compromised soft tissue envelope, and the potential neurovascular compromise. Every effort should be made to quickly and efficiently relocate the disrupted ankle joint. Within the emergency department setting, narcotics and benzodiazepines can be used to sedate the patient before attempting closed reduction. The combination of narcotics and benzodiazepines provides relief of pain and muscle guarding; however, it conveys a risk of seizure as well as respiratory arrest. An alternative to conscious sedation is the hematoma block, or an intra-articular local anesthetic injection in the ankle joint and the associated fracture hematoma. The hematoma block offers a comparable amount of analgesia to conscious sedation without the additional cardiovascular risk, hospital cost, and procedure time.
