Perioperative management of the patient with diabetes mellitus: update and overview.

Perioperative management of diabetic patients involves optimizing glycemic control and negotiating comorbidities to help reduce complications and obtain results on par with nondiabetics. These goals are usually achievable in the elective surgical setting, but they can be more difficult to control in urgent or emergent situations. Understanding and recognizing the comorbidities associated with diabetes is imperative for optimizing outcomes. Regulating hyperglycemia can reduce morbidity, mortality, and postoperative infections. Understanding the effects of cardiac and renal disease is also important. Taking a team approach in managing these complex patients leads to improved outcomes and is now considered the standard of care.

Uniportal endoscopic gastrocnemius recession for treatment of gastrocnemius equinus with a dedicated EGR system with retractable blade.

This study examined the effectiveness and safety of a uniportal endoscopic gastrocnemius recession with a specifically designed uniportal endoscopic system. Fifty-three patients underwent 60 endoscopic gastrocnemius recessions. Their mean range of ankle dorsiflexion changed from a preoperative value of -2.9° ± 1.9° to a postoperative value of 12.8° ± 1.7°, for a total increase of 15.7° ± 1.8° of ankle dorsiflexion (p < .001). The average time from skin incision to closure was 4 minutes and 19 ± 33.6 seconds. Overall, 4 (6.67%) cases (procedures) were associated with a complication, including 1 (1.67%) case of triceps surae weakness that resolved after physical therapy. Three (5%) cases developed nerve complications, with 2 (3.33%) cases of transient neuritis that spontaneously resolved at 5 and 8 weeks postoperatively, respectively, and 1 (1.67%) that experienced persistent cutaneous anesthesia in the distribution of the sural nerve along the lateral aspect of the foot up to 4 months postoperatively. There were no cases of wound dehiscence or delayed healing, painful scar formation, infection at the surgical site, hematoma, or deep venous thrombosis. Endoscopic gastrocnemius recession with a uniportal system appears to be safe and effective.