Use of the Allgöwer-Donati suture technique for wound closure following transmetatarsal amputation.

INTRODUCTION: The Allgöwer-Donati suture technique reportedly has lower incision perfusion impairment compared with other suture techniques. The authors of the present case series hypothesized that suture technique selection to achieve lower incision perfusion impairment may result in improved healing rates and decreased incidence of wound complications in partial foot amputations, specifically TMAs. OBJECTIVE: To evaluate the efficacy of TMA with skin closure completed using the Allgöwer-Donati suture technique. MATERIALS AND METHODS: The records of 7 patients (8 limbs) who underwent closure with the Allgöwer-Donati suture technique after TMA between March 2021 and March 2022 were retrospectively reviewed. Only patients with a diagnosis of gangrene were included. RESULTS: Five of 8 limbs (62.5%) healed uneventfully, with an average time to healing of 3.3 weeks. Six of 8 limbs (75%) healed within 4 weeks, and 1 limb was lost to follow-up. CONCLUSIONS: The results of this small case series suggest that use of the Allgöwer-Donati suture technique may result in decreased incidence of wound complications by allowing improved perfusion at the amputation site.

Osteochondral Allograft Transplant for Degenerative Joint Disease of the First Metatarsophalangeal Joint: A Case Report.

The first metatarsophalangeal joint is the most common location for arthritis in the foot. Pain and limited mobility associated with arthritis of the first metatarsophalangeal joint are the hallmarks of this disease. Treatments include shoe modification, orthotic devices, nonsteroidal anti-inflammatory drugs, injections, physical therapy, and surgery. Surgery has been the most perplexing, with surgical treatments ranging from simple ostectomies to fusion of the first metatarsophalangeal joint. Implant arthroplasty, with its various designs and techniques, has yet to be proven as the definitive solution for first metatarsophalangeal joint arthritis or hallux limitus (unlike the knee and hip). Interpositional arthroplasty and tissue-engineered cartilage grafts also have limitations when dealing with osteoarthritis and hallux limitus of the first metatarsophalangeal joint. In this case report, we present a 45-year-old woman with arthritis of the left first metatarsophalangeal joint who underwent surgical intervention by means of a frozen osteochondral allograft transplant to the first metatarsal head.

Lesser toe deformity classification: A simplified approach with treatment influence.

Deformities of the lesser toes are one of the most commonly treated conditions by foot and ankle surgeons. Despite their frequency, a standardized classification has yet to take hold among providers. Generic nomenclature with the addition of multiple adjunctive descriptors continues to be the standard leading to international confusion. A literature review was conducted to analyze any literature and/or textbooks pertaining to lesser toe deformity classification systems. Seven sources met the inclusion criteria and were analyzed consisting of novel, modified, and previously published systems. A simplified and treatment driven lesser toe deformity classification utilized at the University of Louisville is introduced, which categorizes these deformities into one of two groups. Type 1 deformities are those isolated to the toe only and Type 2 deformities are toe deformities that include metatarsal phalangeal joint involvement. The intent of the University of Louisville Lesser Toe Deformity Classification (LTDC) is to improve communication and documentation, as well as assist surgical planning. LEVEL OF CLINICAL EVIDENCE: 5.