Wound repair, safety, and functional outcomes in reconstructive lower extremity foot and ankle surgery using a dehydrated amnion/chorion allograft membrane.

Amniotic membranes are known to be rich in growth factors, cytokines, and matrix proteins, which can help support wound closure and may improve patient outcomes in foot and ankle surgical interventions. In this Institutional Review Board (IRB) approved clinical study, 21 consecutive patients undergoing lower extremity soft tissue and bone reconstruction surgery received dehydrated human amnion and chorion allograft (dHACA) placed as a covering over the deep layers of the surgical wound during closure. Wound healing complications were assessed and American Orthopaedic Foot and Ankle Society (AOFAS) scores were compiled from over a 1-year follow-up period. Summary statistics were calculated for average pain, function, and alignment. The average overall AOFAS pre-treatment score was 35.8 ± 23.0 and the post-treatment score significantly improved to 87.5 ± 6.4 (P = 3.7 × 10-10 ). The pain-score improved from pre-treatment at 10.0 ± 11.0 to post-treatment at 36.7 ± 4.8 (P = 5.0 × 10-5 ). The pre-treatment function score was 18.7 ± 12.9 and at post-treatment increased to 38.5 ± 5.7 (P = 5.8 × 10-5 ). Lastly, the alignment score at pre-treatment was 7.1 ± 4.4 and at post-treatment was 12.4 ± 2.6 (P = .001). These improvements in functional scores were accompanied with clinical observations of reduced surgical complications including a lack of wound dehisance in the cohort. These clinical findings suggest that the application of aseptically processed dHACA may reduce wound complications and as such may aide in clinical improvements in foot and ankle surgical interventions however a larger comparative trial should be considered to validate these initial findings.

Consideration for Total Ankle Replacement in the Varus Ankle and Cavovarus Foot Type.

The varus ankle and cavus foot pose challenges in surgical correction with regard to total ankle replacement surgery. Etiology of cavus foot type and varus ankle must be evaluated and confirmed. Pes cavus is increased height of the arch with metatarsus adductus and increased calcaneal inclination angle. There often is intrinsic musculature irregularity leading to imbalance of the foot. Although not all cavus foot types and varus ankle deformities are sequelae of neuromuscular disorder, neurologic etiology must be considered. Attaining neutral alignment of ankle joint articular surface is paramount to longevity and functionality of ankle joint replacement implant.

Benchtop comparison of a novel dynamic compression screw to a standard cortical screw: compression integrity and gap size over time during simulated resorption.

Literature reports the incidence of failed isolated foot and ankle fusions as up to 23%. A contributing factor is the natural bone resorption, which occurs resulting in loss of compression and gapping at the fusion site when standard static compression plates and screws are used. However, an innovative dynamic compression screw may provide lasting compression despite resorption. This benchtop study shows that the FxDEVICES spring-loaded dynamic POGO screw maintains more compression and more consistent compression rate during simulated resorption, as compared with a standard compression screw. The novel screw maintained much greater compression strength within the first millimeter of simulated resorption (13.57 vs 4.38 lb) and maintained greater compression strength at the test completion (1.14 vs 0 lb). The novel screw revealed a more consistent resorption rate over the duration of the simulation. Clinically, this may result in more stability and improved fusion rates.