Effect of cryotherapy devices in the postoperative setting.

BACKGROUND: Sophisticated methods of cryotherapy, such as application of a water-circulating device, have recently been popularized to provide a constant or intermittent therapeutic source in the foot and ankle postoperative setting. In this study, the efficacy and safety of three selected cryotherapy devices (Iceman, EBIce, and Ankle Cryo/Cuff) were investigated. METHODS: Each cryotherapy unit, in the coldest setting, was applied over standard surgical dressings in group I, over one layer of Jones compression bandage in group II, and over two layers of Jones compression bandage in group III on four individuals in excellent overall health. The skin temperature was then recorded every 15 min for 180 min in each trial. RESULTS: In group I, the Iceman was the only device that required discontinuation in one subject, and the EBIce and Cryo/Cuff were tolerated in all of the subjects. However, the temperatures in all of the devices continued to decrease at the end of the trials. In group II, all of the cryotherapy devices controlled temperatures between 20 degrees C (68 degrees F) and 30 degrees C (86 degrees F). In group III, no device significantly lowered the initial surface skin temperature. CONCLUSIONS: We achieved the safe and effective temperature range when the cryotherapy devices were applied over one layer of Jones compression dressing. The cryotherapy devices resulted in less predictable temperature declination when applied over the thinner surgical dressing. When the devices were applied over two layers of Jones compression dressing, surface skin temperature declination was minimal.

Syme's amputation: a retrospective review of 10 cases.

Amputation at the level of the ankle joint is a valuable, yet underused procedure for a variety of conditions affecting the foot and ankle. The procedure can provide a comfortable and durable stump that allows a lower extremity amputee to function with minimal disability. The indications, surgical technique, and postoperative prosthetic considerations are reviewed and discussed. Emphasis is placed on the preoperative considerations deemed essential for a successful outcome based on the senior author's experience of 10 cases performed for a wide variety of pathologies. Three case illustrations show the efficacy of the Syme's procedure as an alternative to a higher level amputation, such as below-knee amputation or above-knee amputation.

Techniques of digital arthrodesis: revisiting the old and discovering the new.

Digital surgery is commonplace for foot and ankle surgeons. The techniques of arthrodesis are more exacting and complex than techniques of arthroplasty. They are generally performed in cases of more severe deformity or underlying biomechanical abnormalities, which strongly influence the development and propagation of the deformity. When performed properly in a patient with good compliance, the results are consistently good and rewarding to patients and surgeons. Attention to detail cannot be overemphasized in managing digital deformities. Failure to do so is likely to result in a less than satisfactory outcome for physician and patient. Traditional techniques are proven effective approaches. Meticulous attention to detail and precise execution of the procedure will minimize complications. The exact role of newer implants for fusion is yet to be determined. Further short-term and long-term experience will determine their role in foot surgery.