Biwinged excision for round pedal lesions.

A technique for excising round pedal skin lesions is presented as an alternative to standard elliptic or lenticular excision. Biwinged excision maximally preserves healthy tissue and allows complete excision of a wide variety of lesions from the foot. The authors present a procedural outline of this technique and include several illustrative cases to demonstrate its utility.

Handgun injuries to the foot: treatment of low-velocity, high-energy wound types.

The authors present several cases of gunshot injury to the foot. Classification of wounds according to weapon type and caliber is discussed, as well as treatment rationale. Emphasis is placed on the need for detailed wound history and classification as precursors to adequate therapy. The low-velocity, high-energy wound type is introduced, and its variation from the current low- and high-velocity classifications discussed.

Compartment syndrome of the foot.

Compartment syndrome is a relatively common posttraumatic diagnosis in the forearm and lower leg. Although the existence of this syndrome in the foot has been documented, it is not a well-known entity. Because delays in recognition and treatment can lead to catastrophic complications, practitioners should be aware of both its existence and its presentation. The authors present a case report of pedal compartment syndrome and a discussion of the literature pertaining to its diagnosis and treatment.

Renal cell carcinoma and osseous metastases. Case report and literature review.

Renal cell carcinoma is one of the great mimics in medicine. The diagnosis is complicated by clinical presentations involving a multitude of symptoms, often associated with the sites of metastasis. A high percentage of renal cell carcinomas have metastasized at the time of initial presentation, and symptoms associated with this metastasis may actually initiate the diagnosis. Because the site of tumor origin is frequently unknown, a diagnostic strategy for identifying the primary source has been proposed. The prognosis for renal cell carcinoma with metastasis is poor, with fewer than 9% of patients surviving at 5 years. Consequently, treatment is directed primarily at palliation of painful symptoms and stabilization of bony structures. With these goals in mind, treatment modalities run the gamut from radiotherapy, to curettage with polymethyl methacrylate augmentation, to amputation. In the case reported here, renal cell carcinoma was diagnosed in the course of evaluation of a painful lytic lesion of the foot. Treatment alternatives and associated risks and complications were discussed at some length and the patient chose curettage and packing with polymethyl methacrylate in combination with radiotherapy. This approach was successful in palliation of pain and maintenance of walking ability and independence.

Electrical stimulation of cutaneous ulcerations. A literature review.

The effect of electrical currents on living cellular systems has been studied by many researchers and is becoming useful in clinical medicine. Alteration of cellular activity with externally applied currents can positively or negatively influence the status of a healing tissue, thereby directing the healing process to a desired outcome. A review of the literature pertaining to the effect of electrical currents on tissue healing is presented and the relevance of this modality to ulcer healing is discussed.