RESUMO
Patients with peripheral neuropathy associated with ulceration are the nemesis of the orthopedic foot and ankle surgeon. Diabetic foot syndrome is the leading cause of peripheral neuropathy, and its prevalence continues to increase at an alarming rate. Poor wound healing, nonunion, infection, and risk of amputation contribute to the understandable caution toward this patient group. Significant metalwork is required to hold these technically challenging deformities. Neuropathic Minimally Invasive Surgeries is an addition to the toolbox of management of the diabetic foot. It may potentially reduce the risk associated with large wounds and bony correction in this patient group.
Assuntos
Pé Diabético/cirurgia , Deformidades Adquiridas do Pé/cirurgia , Pé/cirurgia , Procedimentos Cirúrgicos Minimamente Invasivos/métodos , Amputação Cirúrgica , Artropatia Neurogênica/classificação , Artropatia Neurogênica/diagnóstico por imagem , Artropatia Neurogênica/cirurgia , Fenômenos Biomecânicos , Pé Diabético/classificação , Pé Diabético/fisiopatologia , Pé Diabético/terapia , Humanos , Doenças do Sistema Nervoso Periférico/classificação , Doenças do Sistema Nervoso Periférico/complicaçõesRESUMO
BACKGROUND: The arterial supply to the talus has been extensively studied previously but never to specifically examine the subchondral region of the talar dome, a frequent site of localised pathology. This study aims to analyse and quantify the subchondral vascularity of the talar dome. METHODS: We performed cadaveric arterial injection studies. After processing, the vascularity to the subchondral region of the talar dome was visualised and mapped using three-dimensional computer technology, then quantified and reported using a nine-section anatomical grid. RESULTS: The areas of relative poor perfusion across the talar dome are the posterior/medial, posterior/lateral and middle/medial sections of a nine-section grid. The rest of the subchondral region shows more richly vascularised bone. CONCLUSIONS: The vascularity of the subchondral surface of the talar dome is not uniformly distributed. This may be relevant to the aetiology and management of osteochondral lesions and shows some correlation with their more frequent locations.
