1/106. Treatment of late ulceration in free muscle flaps to the foot.One of the preferred methods for the repair of large defects of the foot has been the use of free muscle flaps covered with skin grafts. Although this method has served well, some patients will experience ulceration in the weight-bearing surface. Three cases are reported in which small ulcerations developed in the heel after reconstruction of traumatic defects with muscle free flaps. All three patients were treated with a neurovascular island flap from the side of the great toe. All three patients are active young males, and all three patients have subsequently maintained intact skin for an average of 6.8 years (range, 5.1 to 9.1 years).- - - - - - - - - - ranking = 1keywords = ulcer (Clic here for more details about this article) |
2/106. A simplified method of total contact casting for diabetic foot ulcers.A simplified method of total contact casting for diabetic plantar ulcerations is described in which a standard, well-molded short-leg walking cast is applied. Weekly cast changes are performed initially, followed by longer cast change intervals. Either fiberglass or plaster casting tape appears equally efficacious. Healing of all ulcers was demonstrated in 12 patients treated with this technique.- - - - - - - - - - ranking = 1.0001041105187keywords = ulcer, leg (Clic here for more details about this article) |
3/106. mycosis fungoides masquerading as an ischemic foot.This case is of a man with bilateral lower-extremity ischemia and a solitary nonhealing ulcerated lesion of the right great toe. After revascularization with an aortobifemoral bypass, his right ABI increased from 0.5 to approximately 0.75, but the ulcerated toe lesion did not show signs of healing and instead progressed to a deeper ulceration exposing bone. Because of presumptive osteomyelitis, we performed a great toe amputation, and immunohistochemical analysis of the lesion revealed late plaque stage mycosis fungoides (MF). We present this case to alert the vascular surgeon to this diagnostic possibility when confronted with an apparent ischemic lesion and to describe what made this particular lesion suspicious for MF. To the best of our knowledge, this is the first case of MF presenting solely as an ischemic lesion.- - - - - - - - - - ranking = 0.5keywords = ulcer (Clic here for more details about this article) |
4/106. Reverse flow instep island flap.The retrogradely perfused medial plantar artery flap was used in a leprosy patient with a plantar ulcer over the heads of the second and third metatarsals. The flap is based on the anastomosis of the medial plantar artery with the branch of the first plantar metatarsal artery, which supplies the medial side of the great toe. This design provides reconstruction with like local tissues while not distorting the weight-bearing pattern of the foot.- - - - - - - - - - ranking = 0.16666666666667keywords = ulcer (Clic here for more details about this article) |
5/106. The effect of hallux valgus correction on chronic plantar ulceration. A case report.Plantar pressure-measurement technology may provide the clinician with valuable objective information for monitoring the effects of therapeutic intervention on the foot. The use of this technology is described in the preoperative and postoperative assessment of a patient undergoing hallux valgus surgery for the treatment of a chronic neuropathic skin ulcer over the medioplantar aspect of her first metatarsophalangeal joint.- - - - - - - - - - ranking = 0.83333333333333keywords = ulcer (Clic here for more details about this article) |
6/106. Frozen allogeneic human epidermal cultured sheets for the cure of complicated leg ulcers.BACKGROUND: Skin ulcers due to venous stasis or diabetes are common among the elderly and are difficult to treat. Repeated applications of cell-based products have been reported to result in cure or improvement of leg ulcers of small size in a fraction of patients. OBJECTIVE: To examine the effects of frozen human allogeneic epidermal cultures for the treatment of acute and chronic ulcers. methods: We treated a series of 10 consecutive patients with leg ulcers of different etiology and duration with frozen human allogeneic epidermal cultures stored frozen and thawed for 5-10 minutes at room temperature before application. Three patients had ulcers with exposed Achilles or extensor tendon. The ulcers treated were as large as 160 cm2 in area and of up to 20-years' duration. After preliminary preparation of the wounds by debridement to remove necrotic tissue and application of silver sulfadiazine to control infection, thawed cultures were applied biweekly from 2 to 15 times depending on the size and complexity of the ulcer. RESULTS: All ulcers healed, including those with tendon exposure. After the first few applications, granulation tissue formed in the ulcer bed and on exposed tendons, and epidermal healing took place through proliferation and migration of cells from the margins of the wound. The time required for complete healing ranged from 1 to 31 weeks after the first application. CONCLUSION: The use of frozen human allogeneic epidermal cultures is a safe and effective treatment for venous or diabetic ulcers, even those with tendon exposure. It seems possible that any leg ulcer will be amenable to successful treatment by this method.- - - - - - - - - - ranking = 2.9304416199021keywords = ulcer, leg ulcer, leg (Clic here for more details about this article) |
7/106. Paramalleolar bypass concomitantly with extended endarterectomy for limb-threatening ischemia: A case report.A 74-year-old male was admitted to our university hospital with a refractory ulcer of the left third toe. The ankle pressure index was 0.43. On his angiogram, the popliteal artery was totally occluded in the distal site, while the peroneal artery was solely patent and inflowed into the distal posterior tibial artery. At surgery, endarterectomy of 7 cm in length was performed on the tibioperoneal trunk of the occluded popliteal artery following patch repair using a saphenous vein to restore the genicular arterial network and infrapopliteal arteries. Thereafter, the bypass surgery was performed using the in situ saphenous vein from the patent proximal popliteal artery to the distal posterior tibial artery. The postoperative angiogram showed patency of the graft as well as restoration of the genicular arterial network and infrapopliteal arteries. The ankle pressure index improved to 1.04, and the refractory ulcer was completely cured one month after revascularization.- - - - - - - - - - ranking = 0.33333333333333keywords = ulcer (Clic here for more details about this article) |
8/106. Treatment of stingray injury with topical becaplermin gel.Stingray injuries are most commonly characterized by localized pain, ulceration, and edema; however, potentially serious sequelae may result, including tissue necrosis and life-threatening infection. This case report describes a stingray injury that had progressed to ulceration and was treated with topical application of recombinant human platelet-derived growth factor-BB (becaplermin gel 0.01%) and a standardized regimen of wound care.- - - - - - - - - - ranking = 0.33333333333333keywords = ulcer (Clic here for more details about this article) |
9/106. Soft-tissue reconstruction of sole and heel defects with free tissue transfers.Reconstruction of the weight-bearing surface of the foot is a challenging problem for the reconstructive surgeon. Because local tissues are not usually available for reconstruction, distant tissue transfers are often necessary. The authors report 20 patients with sole and heel defects that were reconstructed with free flaps. Two patients had bilateral reconstruction. Three patients were younger than 10 years. Etiological causes were burn scar (N = 7), trauma (N = 7), chronic wound (N = 3), and tumor resection (N = 5). All defects were located at a weight-bearing area. Gracilis muscle (N = 11), neurosensorial radial forearm (N = 7), latissimus dorsi muscle (N = 2), rectus abdominis muscle (N = 1), and posterolateral thigh flaps (N = 1) were used for reconstruction. Muscle flaps were preferred for the deep and irregular defects or chronic, open infected wounds. All flaps survived except for one total and two partial complications of necrosis. recurrence of ulceration was observed in 1 patient with spinal cord trauma. The mean follow-up period was 33.7 months (range, 1-84 months). patients were evaluated by direct gait observation, footprints, pedograms, and the Semmes-Weinstein monofilament test. All patients returned to normal daily activity with individual gait patterns. Functional outcomes of both muscle and fasciocutaneous flaps were satisfactory. Presence of deep sensation, preservation of musculoskeletal integrity, and patient compliance are the main factors for durability of reconstruction.- - - - - - - - - - ranking = 0.16666666666667keywords = ulcer (Clic here for more details about this article) |
10/106. Filleted toe flap for chronic forefoot ulcer reconstruction.Chronic plantar and dorsal forefoot ulcer may result from injury, structural deformity, and abnormal sensation or circulation. It is not uncommon that the distal portion of the affected toes is deficient functionally in these patients. A filleted toe flap from the expendable functionless toe can provide a durable, stable, and sensate skin flap of 4 to 5.5 cm for coverage of the forefoot defect. In this report, five cases of dorsal forefoot defects and four cases of plantar forefoot defects due to ischemia (N = 3), trophic change (N = 2), and diabetes (N = 4) were treated with filleted toe flaps. One flap failed due to postoperative deep infection. The other eight filleted toe flaps survived but 2 patients underwent secondary amputations 7 months and 2 two years later because of secondary diabetic foot infections.- - - - - - - - - - ranking = 0.83333333333333keywords = ulcer (Clic here for more details about this article) |
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