Treatment of venous ulcers with human skin equivalent.

In the author's clinical experience in rating venous ulcers, human skin equivalent has been efficacious, safe, cost-effective, and easy to use. This innovation is likely to become an important therapeutic tool for podiatric physicians who treat venous ulcers. Leg ulcers are a large economic burden to society, both in direct and total costs, including patient time lost from work for labor- and time-intensive therapies. The cost-containing measures of the managed care environment encourage treatment of venous ulcers in an outpatient center. Because human skin equivalent can be applied in such a setting, podiatric physicians will be able to treat venous ulcers routinely without referring patients to more costly settings such as hospitals or surgical centers. Because human skin equivalent is an effective alternative to standard venous ulcer therapies, this agent, which is currently under review by the Food and Drug Administration, should provide a viable treatment that may reduce the total costs associated with venous ulcer care.

Enhanced healing of ulcers in patients with diabetes by topical treatment with glycyl-l-histidyl-l-lysine copper.

A multicenter, randomized, evaluator-blinded, placebo-controlled clinical study was conducted to evaluate the safety and effectiveness of glycyl-l-histidyl-l-lysine: copper complex (lamin Gel) in the treatment of diabetic neuropathic ulcers. All patients were enrolled in an aggressive standardized wound care protocol consisting of sharp debridement at study entry, daily application of a metered dose of drug, standardized pressure-relieving footwear, and patient education relating to diabetes control and activity modifications. Treatment with lamin Gel significantly increased the percentage of closure of plantar ulcers (98.5% median area percentage closure compared with 60.8% for vehicle; p < 0.05) and the proportion of patients healing 98% or better. The rate of closure was three times faster with lamin Gel treatment compared with standard care and vehicle. The enhancement of wound closure was more pronounced (median of 89.2% compared with -10.3% for vehicle; p < 0.01) in larger (greater than 100 mm(2) initial area at study entry) plantar ulcers caused by the failure of this size of ulcer to respond adequately to standardized wound care treatments in the absence of lamin Gel. Treatment must commence immediately after the initial wound debridement to obtain optimal enhancement of the ulcer closure. The incidence of ulcer infections was significantly lower (7% incidence compared with 34% for vehicle, p < 0.05) in the plantar ulcers treated immediately after debridement with the lamin Gel.

Diffuse type tenosynovial giant cell tumor of the ankle.

The case presented was of a tenosynovial giant cell tumor, diffuse type. The lesion had an apparent communication with the talonavicular joint, as well as a possible communication with the ankle joint. The inevitable morbidity, as well as the lack of an intraoperative definitive diagnosis, prevented a more radical excision of the lesion. The apparent association with a joint will predilect the patient to a higher rate of recurrence but not, however, to a malignant degeneration.

First metatarsophalangeal joint arthrodesis. Treatment for sesamoid fractures.

Fractures of both hallucal sesamoids are not commonly reported in the literature. The authors address various surgical procedure choices and present a case history. In their case, conservative treatment failed; therefore, surgical intervention was elected, and fusion of the first metatarsophalangeal joint was performed.

Silver sulfadiazine and hydrocortisone cream 1% in the management of phenol matricectomy.

The phenol matricectomy is one of the most common procedures performed in the podiatrist's office. Since a chemical burn is produced, correct care of the wound is essential. The authors studied the use of silver sulfadiazine, hydrocortisone cream, and a mixture of the two, on wounds resulting from phenol matricectomy procedures. The study shows that when silver sulfadiazine and hydrocortisone are used in combination, some of the usual sequelae seen with phenol matricectomies are markedly reduced and wound healing progresses at a more rapid rate with less complications.

Bone scan: indium-WBC correlation in the diagnosis of osteomyelitis of the foot.

A retrospective study was performed of 20 podiatric cases using technetium-99m methylene diphosphonate three-phase bone scans along with indium-111 oxine leukocyte scans, as needed, to determine the presence and extent of osteomyelitis of the foot. Using criteria developed at our institution, the authors attempt to provide a mechanism to make a reliable diagnosis for osteomyelitis that has been supported by surgical/pathologic confirmation of long-term clinical follow-up. The sensitivity, using bone scans alone, was 100%, and specificity was 47%. Correlating bone and indium-111 leukocyte scans yielded a sensitivity of 100% with a specificity raised to 81%. Indium-111 leukocyte scans were used in 40% of cases when a definitive diagnosis for osteomyelitis could not be made on the basis of the three-phase bone scan or clinical presentation alone. Indium-111 leukocyte scans were also helpful in delineating the extent of the disease process. The authors present a standard technique for a 5-hour delayed imaging in the three-phase bone scan, as well as marking the foot in the indium-111 leukocyte scan with three routine views obtained for each imaging procedure, to ensure clinical accuracy.

A comparison of transpositional neurovascular skin flaps for reconstruction of diabetic heel ulcerations.

The diabetic heel ulcer is a common, yet difficult, entity to manage. Conservative and surgical treatments are frequently unsuccessful. Transpositional neurovascular skin flaps offer a relatively new and effective method for reconstruction of this defect. The medial plantar, dorsalis pedis, and lateral calcaneal flaps are discussed and compared for use in the diabetic patient with heel ulceration.

Late neuropathic sequelae of cold injury.

The authors discuss long-term effects of cold injury on five patients seen at the Veterans Administration Medical Center. They review pertinent scientific literature; but suggest a void exists in reports of late effects on tissues. More extensive research on a larger patient population is recommended.

Superficial dysesthesias secondary to epidermoid cyst of the foot.

This paper presents a case history of dysesthesias of the lateral branch of the superficial peroneal nerve secondary to compression by an epidermoid cyst in the foot of a 42-year-old patient.