An Open-label, Single-center, Retrospective Study of Cryopreserved Amniotic Membrane and Umbilical Cord Tissue as an Adjunct for Foot and Ankle Surgery.

The primary aim of this study was to compare preoperative assessments with postoperative outcomes from patients undergoing foot and ankle revisions and/or complex reconstructions with tendon and/or nerve involvement using cryopreserved human amniotic membrane and umbilical cord (cHAM/UC). We hypothesized complex foot and ankle surgery using amniotic membrane would be an effective treatment leading to reduced pain and improved functional outcomes. Fourteen patients (6 male and 8 female) underwent open foot and ankle surgery during the study period. All 14 patients included in this cohort reported improvement, namely, lessened pain intensity both on the American Orthopedic Foot and Ankle Society (AOFAS) Ankle-Hindfoot Scale and the pain numeric rating scale (NRS), as well as improved functional status. The mean AOFAS score improved from 50 (range, 17-79) preoperatively to 85 (range, 67-100) postoperatively. The mean NRS score also improved from 8 (range, 4-10) preoperatively to 2 (range, 0-6) postoperatively with a mean percent change in pain NRS of 78% (range 17-100%). Both outcome-scoring systems showed statistically significant differences (p < .0001) when we compared the preoperative and postoperative results. All patients included in the cohort showed improvement in both outcome measures. Further study of long-term endpoints is warranted.

A brief survey on prescriber beliefs regarding compounded topical pain medications.

Pain is extremely common in the U.S. It is estimated that 116 million Americans suffer from chronic pain. Narcotics and opioid medications are heavily relied upon for the treatment of pain. Currently, there is an epidemic of opioid abuse and misuse in the U.S. and alternative methods for the treatment of pain are required. Topical compounded pain creams are thought to be one such alternative. The purpose of this study was to establish a baseline regarding the beliefs of community physicians on the safety and efficacy of these compounds. A survey was sent to practicing physicians in the U.S. regarding their prescribing behaviors for topical compounds, as well as their beliefs about the efficacy and safety of these medications. Eleven prescribing practitioners participated in this survey with a response rate of 78%. The results were compiled with basic statistical work (Excel). This survey demonstrated that at the time of the study, topical compound creams for the treatment of pain were commonly used in clinical practice; these creams were used for musculoskeletal pain and for neuropathic pain. It was also determined that the vast majority of practicing prescribers felt that compounded pain creams were more efficacious than mass-produced, U.S. Food and Drug Administration-approved creams marketed by large multi-national pharmaceutical companies. Most of the respondents felt that these compounds allowed them to reduce their narcotic prescriptions overall. In addition, the results demonstrated that the prescribers felt these compounds were safe for their patients. In this small survey of practicing prescribing providers regarding the use of topical compounds, we found that these medications were not only effective but also safe.

Comparison of vacuum-assisted closure to the antibiotic bead pouch for the treatment of blast injury of the extremity.

The surgical care of modern combatants involves treatment of massive extremity wounds from blast mechanism. Currently up to 70% of combat wounds are extremity related. Clinical outcomes for these patients are dependent on the care of these wounds. The Vacuum-Assisted Closure (VAC) Therapy system (KCI Inc, San Antonio, Texas) is ubiquitous in theater and is often considered the only way to treat these wounds. However, the VAC Therapy system is not without problems. It is expensive and requires extensive amounts of product and machinery, as well as functioning suction, and therefore a power source at all times. In addition, the VAC Therapy system requires a trained and vigilant nursing staff. We hypothesized that the antibiotic bead pouch would be a viable alternative to the VAC Therapy system for such blast injuries. We retrospectively analyzed 2 matched groups of 12 patients in terms of outcome and cost. We found that the VAC Therapy system produced more late methicillin-resistant Staphylococcus aureus infections (30%), more unanticipated returns to the operating room for wound problems (4:12 vs 0:12), and required more surgeries overall until closure of the wounds. In addition, the VAC Therapy system cost $12,000 more for 12 patients than the antibiotic bead pouch. We recommend the bead pouch be considered as an equivalent option to the VAC Therapy system in the treatment of blast injury.

Ethnic radiographic foot differences.

BACKGROUND: The prevalence of foot and ankle conditions varies among different ethnic groups. It is not known if this difference is due to any distinctive skeletal morphological characteristics of the foot. The purpose of this study was to determine if ethnic differences exist in the morphometric measurements on radiographs of the weightbearing foot. MATERIALS AND METHODS: A morphometric study of weightbearing radiographs of feet was performed prospectively. Radiographic parameters were measured on digital monitors using digital tools. These were the hallux valgus angle (HVA), intermetatarsal angle (IMA), talonavicular angle (TNA), talonavicular coverage angle (TNCovA), metatarsal span (MS) on anteroposterior (AP) radiographs and talo-first metatarsal angle (T-1(st)MTA), calcaneal pitch (CP), and lateral talocalcaneal angle (LTCA) on lateral radiographs. RESULTS: A total of 237 feet in 126 patients (45 African Americans, 59 Caucasians, and 22 Hispanics) were studied. Statistically significant differences were found in the CP, LTCA, and MS. African Americans have significantly lower CP than Caucasians (p < 0.0001). African Americans have significantly lower CP than Hispanics (p < 0.0016). Caucasians have significantly higher TCA than African Americans (p < 0.0004). Males have a larger MS than females (p < 0.0001). CONCLUSION: There are differences in the radiographic morphology of feet among different ethnic groups. A larger prospective community-based study of morphological differences is needed for better understanding of the genetic and environmental factors influencing the prevalence of foot and ankle conditions. CLINICAL RELEVANCE: The clinical relevance between having a lower CP angle and a higher incidence of flat feet in African Americans warrants further investigation. It is not known if there is a relationship between posterior tibialis insufficiency and low CP.

MR imaging of ankle inversion injuries.

Ankle inversions are common in the general population and in athletes. Multiple concurrent injuries are a common result of an ankle-inversion injury. Syndesmosis injury, lateral ankle ligament tears, peroneal retinaculum or tendon injury, osteochondral lesion, or fracture may occur. Chronic pain or instability may result from one or more of these injuries. MR imaging provides superior soft tissue resolution, high sensitivity for occult fractures, and the ability to image the articular cartilage and ankle ligaments directly. This article discusses the MR imaging evaluation of acute and chronic ankle inversion injuries.

Extracorporeal bypass preserved composite anterior thigh free flap (periosteo-musculo-fascio-cutaneous) for hemipelvectomy reconstruction: utilizing the periosteal component for abdominal wall fascial reconstruction.

We present a case of a right external hemipelvectomy for chondroblastic osteosarcoma originating from the right ilium and reconstruction with salvage parts; cardiopulmonary bypass preserved anterior thigh free flap. The resection required sacrifice of the right common iliac artery and vein and the entire right gluteus maximus muscle. The first stage of the procedure was a high above-knee amputation on the ipsilateral leg. The amputated extremity was placed on extracorporeal bypass utilizing the common femoral artery and vein. This technique, previously unreported, supported the successful utilization of the anterior thigh free flap for both soft tissue and abdominal wall facial reconstruction.