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Dhagey IA, Liu ZX, Zhong HF, Chen P, Qalalwa M, Martin VT, Ulrich M, Jiang N, Yu B. Pediatric calcaneal osteomyelitis: an analysis of literature-reported 128 cases. BMC Infect Dis 2024; 24:998. [PMID: 39294568 PMCID: PMC11409617 DOI: 10.1186/s12879-024-09887-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2024] [Accepted: 09/05/2024] [Indexed: 09/20/2024] Open
Abstract
BACKGROUND Calcaneal osteomyelitis (CO) poses a formidable challenge in treatment due to the distinct anatomical structure and functional properties of the calcaneus. The present study endeavors to furnish a thorough and comprehensive understanding of the clinical manifestations, therapeutic strategies, and therapeutic outcomes pertaining to pediatric calcaneal osteomyelitis (PCO) by conducting a meticulous synthesis and analysis of cases reported in the literature. METHODS A systematic search of the PubMed, Embase, and Cochrane Library databases was conducted to identify English-language studies analyzing PCO between 2000 and 2021. The quality of the included studies was assessed using the National Institutes of Health (NIH) assessment scale. Effective data were extracted and analyzed. RESULTS A total of 42 studies, encompassing 128 patients, fulfilled the established inclusion criteria. The gender distribution revealed a male-to-female ratio of 2:1 (81 boys and 40 girls). The median age at the time of diagnosis was 8 years, while the median duration of symptoms was 0.6 month. Trauma emerged as the primary etiology (41 cases, 54%), and limited activity was the most prevalent symptom (68 cases). The positive rate for pathogen culture was 75.4% (49/65), with Staphylococcus aureus being the most commonly isolated pathogen (28 cases, 57.1%). Surgical intervention was performed in 51% (64/126) of the patients, with debridement serving as the primary surgical strategy. The rate of infection recurrence was 6.8% (8/118), and the risk of below-knee amputation was 0.8% (1/124). CONCLUSIONS PCO occurred more frequently in male patients, with trauma being the primary underlying cause and Staphylococcus aureus being the most prevalent bacterial pathogen isolated. Over half of the patients underwent surgical intervention. Nonetheless, it is imperative that treatment strategies undergo further refinement, as approximately 7% of patients experienced infection recurrence.
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Affiliation(s)
- Ismail Ahmed Dhagey
- Division of Orthopaedics and Traumatology, Department of Orthopaedics, Nanfang Hospital, Southern Medical University, No. 1838, Guangzhou Avenue North, Baiyun District, Guangzhou, 510515, China
- Guangdong Provincial Institute of Orthopaedics and Traumatology, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Zi-Xian Liu
- The Second Hospital & Clinical Medical School, Lanzhou University, Lanzhou, China
- Department of Orthopedics, Lanzhou University Second Hospital, Lanzhou, China
| | - Hong-Fa Zhong
- Department of Trauma Emergency Center, Ganzhou Hospital-Nanfang Hospital, Southern Medical University, Ganzhou, China
| | - Peng Chen
- Department of Orthopaedics, Hainan General Hospital, Hainan Hospital affiliated to Hainan Medical University, Haikou, China
| | - Mahmoud Qalalwa
- Division of Orthopaedics and Traumatology, Department of Orthopaedics, Nanfang Hospital, Southern Medical University, No. 1838, Guangzhou Avenue North, Baiyun District, Guangzhou, 510515, China
| | - Vidmi Taolam Martin
- Division of Orthopaedics and Traumatology, Department of Orthopaedics, Nanfang Hospital, Southern Medical University, No. 1838, Guangzhou Avenue North, Baiyun District, Guangzhou, 510515, China
| | - Mizero Ulrich
- Division of Orthopaedics and Traumatology, Department of Orthopaedics, Nanfang Hospital, Southern Medical University, No. 1838, Guangzhou Avenue North, Baiyun District, Guangzhou, 510515, China
| | - Nan Jiang
- Division of Orthopaedics and Traumatology, Department of Orthopaedics, Nanfang Hospital, Southern Medical University, No. 1838, Guangzhou Avenue North, Baiyun District, Guangzhou, 510515, China.
- Guangdong Provincial Institute of Orthopaedics and Traumatology, Nanfang Hospital, Southern Medical University, Guangzhou, China.
- Department of Trauma Emergency Center, Ganzhou Hospital-Nanfang Hospital, Southern Medical University, Ganzhou, China.
| | - Bin Yu
- Division of Orthopaedics and Traumatology, Department of Orthopaedics, Nanfang Hospital, Southern Medical University, No. 1838, Guangzhou Avenue North, Baiyun District, Guangzhou, 510515, China.
- Guangdong Provincial Institute of Orthopaedics and Traumatology, Nanfang Hospital, Southern Medical University, Guangzhou, China.
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Masadeh S, Perry W, Ellabban MA, Bibbo C, Liette MD. Anatomical Variations of the Medial Plantar Artery Flap: A Cadaveric Study With Clinical Applications. J Foot Ankle Surg 2024; 63:526-531. [PMID: 38718967 DOI: 10.1053/j.jfas.2024.04.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2024] [Accepted: 04/22/2024] [Indexed: 06/22/2024]
Abstract
The medial plantar artery flap (MPAF) presents both unique value as well as significant challenges. As the plantar foot has specific anatomy, the use of the MPAF to recreate this highly specialized area may provide improvements in durability and rates of limb salvage. The purpose of this study is to establish the anatomic course of the branching patterns of the medial plantar artery (MPA) and provide a foundation for MPA flap nomenclature as it is related to design and elevation. Thirty-seven fresh frozen cadaver feet were used for dissection: 20 right and 17 left sided limbs. Anatomic measurements recorded included: branching pattern of the MPA, bifurcation distance of the superficial branch (SB) and deep branch (DB) from the origin of the MPA, distance from the MPA origin to the anterior colliculus of the medial malleolus, and the distance from the SB and the DB to the navicular tuberosity. The MPA was found to bifurcate into SB and DB in 30 (81%) specimens; 6 (16%) specimens had only a SB, whereas 1 (3%) specimen had only a DB, which had not been previously described. The distance from the anterior colliculus to the MPA was 3.0 cm, MPA to the distal bifurcation was 2.9 cm, and navicular tuberosity to the SB and DB was 2.2 cm and 1.3 cm, respectively. Minimizing the complexity of the dissection with the use of more reliable landmarks and a deeper understanding of the anatomy may reduce complications and allow for more reproducible outcomes when utilizing the MPAF.
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Affiliation(s)
- Suhail Masadeh
- Associate Professor of Surgery University of Cincinnati Medical Center, Director of Podiatric Surgery Residency University of Cincinnati Medical Center, Chief of Surgical Podiatry Cincinnati Veterans Affairs Medical Center, Cincinnati, OH
| | - William Perry
- Cincinnati Veterans Affairs Medical Center, Veterans Affairs Hospital, Cincinnati, OH
| | - Mohammed A Ellabban
- Assistant Professor of Plastic and Reconstructive Surgery, Suez Canal University Hospitals and Medical School, Ismailia, Egypt
| | - Christopher Bibbo
- Chief, Foot & Ankle, Reconstructive Plastic & Microsurgery & Limb Salvage, Musculoskeletal Infection & Orthopaedic Trauma, Rubin Institute for Advanced Orthopaedics, International Center for Limb Lengthening, Sinai Hospital of Baltimore, Baltimore, MD
| | - Michael D Liette
- Assistant Professor of Surgery, Department of Orthopedics, University of Cincinnati Medical Center, Cincinnati, OH.
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Yammine K. Conservative surgery in the management of diabetic foot complications (excluding Charcot). The role of the orthopedic surgeon. J Clin Orthop Trauma 2024; 55:102513. [PMID: 39228922 PMCID: PMC11367647 DOI: 10.1016/j.jcot.2024.102513] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2024] [Revised: 07/08/2024] [Accepted: 08/10/2024] [Indexed: 09/05/2024] Open
Abstract
Diabetic foot complications (DFC) such as ulcers and infection are the leading cause for non-traumatic non-oncologic amputations worldwide with a 5-year mortality reaching 70 %. Every attempt is warranted to preserve the limb for physical and psychological integrity of these patients. When possible to perform, conservative surgeries could save the foot and its function. This review will focus on those procedures that do not require in-depth surgical or microsurgical skills and that could be performed by general orthopedic surgeons. Along with the technical description and specific indication, a literature search was performed to locate the evidence in relation with the efficacy of these procedures. The procedures could be described in 3 categories: bony surgeries, soft tissue procedures and orthoplastic techniques. The bones surgeries include resection arthroplasty, metatarsal osteotomy, internal pedal amputation, distal Symes amputation, cement augmentation and partial or total calcanectomy. Soft tissue procedures include Achilles tendon lengthening, gastrocnemius recession, toe flexor tenotomy and tendon transfer. The reconstructive/orthoplastic techniques include skin grafting, local flaps, fillet flap and regional flaps, mainly the reverse sural flap. Though most of these conservative surgeries have been shown to yield good to excellent results, the indication for each surgery could be confusing. The role of the orthopedic surgeon is fundamental for the optimal treatment of DFC. Though most procedures are easy to learn and to perform without the need of extra surgical skills, mastering indications is key for successful outcomes. In addition, the knowledge of these limb preserving techniques could be paramount in rural areas or if no foot and ankle surgeons are available.
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Affiliation(s)
- Kaissar Yammine
- Department of Orthopedic Surgery, Lebanese American University Medical Center-Rizk Hospital, Lebanese American University, School of Medicine, Lebanon
- Diabetic Foot Clinic, Lebanese American University Medical Center-Rizk Hospital, Beirut, Lebanon
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Toepfer A, Potocnik P, Harrasser N, Schubert T, Khan Z, Farei-Campagna JM. Principles of Defect Reconstruction After Wide Resection of Primary Malignant Bone Tumors of the Calcaneus: A Contemporary Review. FOOT & ANKLE ORTHOPAEDICS 2024; 9:24730114241266247. [PMID: 39132497 PMCID: PMC11316265 DOI: 10.1177/24730114241266247] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/13/2024] Open
Abstract
Visual AbstractThis is a visual representation of the abstract.
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Affiliation(s)
- Andreas Toepfer
- Kantonsspital St. Gallen, Orthopaedics and Traumatology, St. Gallen, Switzerland
| | - Primoz Potocnik
- Kantonsspital St. Gallen, Orthopaedics and Traumatology, St. Gallen, Switzerland
| | - Norbert Harrasser
- ECOM Excellent Center of Medicine, Munich, Germany
- Department of Orthopaedics and Sportorthopaedics, Klinikum rechts der Isar Technical University Munich, München, Germany
| | - Thomas Schubert
- Cliniques universitaires Saint-Luc, Orthopaedics and Traumatology, Brussels, Belgium
| | - Zeeshan Khan
- Rehman Medical Institute, Department of Trauma and Orthopaedic Surgery, Peshawar, KP, Pakistan
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Kostiuk V, Gazes M, Fereydooni S, Chaar CIO, Guzman RJ, Tonnessen BH. Long-term limb salvage and functional outcomes for patients undergoing partial calcanectomy. Vascular 2024:17085381241247627. [PMID: 38631330 DOI: 10.1177/17085381241247627] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/19/2024]
Abstract
INTRODUCTION Partial calcanectomy (PC) can be performed to treat chronic heel ulcers in patients with calcaneal osteomyelitis. Patients undergoing PC often have multiple comorbidities, limited mobility, and face high risk of major limb amputation. This study examined the extent of vascular diagnostic testing and interventions as well as long-term outcomes in patients undergoing PC. METHODS A retrospective analysis was performed on patients who underwent PC for non-healing calcaneal ulcer over a ten-year period. Demographics, comorbidities, vascular testing, and procedural data were recorded. Additional subgroup analysis was performed according to presence or absence of peripheral arterial disease (PAD). Primary outcomes were major limb amputation (above or below the knee) and mortality. Secondary outcomes included successful wound healing, time to complete wound healing, re-interventions, and change in ambulatory status. RESULTS A total of 157 patients underwent partial calcanectomies on 162 limbs. 78.3% of patients had diabetes mellitus and 47.8% were diagnosed with PAD. Ankle brachial index with pulse volume recording (ABI/PVR) was performed for 46.5% (73/157) of patients, arterial duplex in 44.6% (70/157), and 19.7% (31/157) had a computed tomography angiogram. Lower extremity revascularization was performed in 28.4% of limbs (46/162). Independent ambulatory status was reported in 40.1% prior to PC and decreased to 17.9% by the time of last recorded follow-up (p < .00001). Long-term amputation-free survival was significantly higher in patients without PAD at 7 years (78.4% vs 57.1%, p = .02). Multivariate logistic regression analysis demonstrated that PAD and end-stage renal disease (ESRD) increased the odds of major limb amputation (OR 3.5 and 2.8, respectively), whereas ESRD and adjuvant podiatric procedures were associated with increased mortality (OR 4.8 and 4.8, respectively). CONCLUSION Non-invasive vascular testing should be obtained in all patients undergoing PC, in order to stratify risk of amputation and identify candidates for revascularization. Over the long-term, patients undergoing PC face significant risk of prolonged wound healing, decline in ambulatory status, and major limb amputation.
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Affiliation(s)
| | - Michael Gazes
- Department of Podiatric Surgery, Yale New Haven Hospital, New Haven, CT, USA
| | | | - Cassius Iyad Ochoa Chaar
- Division of Vascular Surgery and Endovascular Therapy, Department of Surgery, Yale University School of Medicine, New Haven, CT, USA
| | - Raul J Guzman
- Division of Vascular Surgery and Endovascular Therapy, Department of Surgery, Yale University School of Medicine, New Haven, CT, USA
| | - Britt Hansen Tonnessen
- Division of Vascular Surgery and Endovascular Therapy, Department of Surgery, Yale University School of Medicine, New Haven, CT, USA
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Yammine K, Alqaysi B, Mansour J, Otayek J, Daher J, Assi C. Gentamicin-permeated cement to sustain mechanical support for the treatment of a chronic calcaneal abscess. A case report. Int J Surg Case Rep 2023; 111:108846. [PMID: 37729823 PMCID: PMC10514422 DOI: 10.1016/j.ijscr.2023.108846] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2023] [Revised: 09/13/2023] [Accepted: 09/14/2023] [Indexed: 09/22/2023] Open
Abstract
INTRODUCTION AND IMPORTANCE Chronic calcaneal osteomyelitis is a challenging condition associated with high relapse rates, requiring a multidisciplinary approach and various therapeutic options for effective management. We report a very rare case of a pyogenic osteomyelitis of the os calcis presented as a bone abscess. CASE PRESENTATION A diabetic male patient presented with chronic osteomyelitis of the calcaneus in the form of bone abscess with a cavity of 6*5 cm. After pus evacuation and debridement of the cavity, gentamycin-impregnated polymethylmethacrylate cement was used to locally assist in controlling the infection and to assure mechanical support. Antibiogram-based oral antibiotic was administrated for 6 weeks. At final follow-up, the patient could walk without any assistance and was able to raise his body on the operated heel, with no signs of infection. CLINICAL DISCUSSION This case illustrates successful conservative surgical treatment of calcaneal abscess using antibiotic-impregnated cement for mechanical support and local infection control. CONCLUSION Incorporating antibiotic-impregnated cement into conservative foot surgeries for deeply embedded calcaneal abscesses provides effective infection control, mechanical support, and functional preservation, leading to successful treatment outcomes.
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Affiliation(s)
- Kaissar Yammine
- Department of Orthopedic Surgery, Lebanese American University Medical Center-Rizk Hospital, Lebanese American University, School of Medicine, Lebanon; Diabetic Foot Clinic, Lebanese American University Medical Center-Rizk Hospital, Beirut, Lebanon; Center for Evidence-Based Anatomy, Sport & Orthopedics Research, Lebanon.
| | - Bilal Alqaysi
- Department of Orthopedic Surgery, Lebanese American University Medical Center-Rizk Hospital, Lebanese American University, School of Medicine, Lebanon
| | - Jad Mansour
- Department of Orthopedic Surgery, Lebanese American University Medical Center-Rizk Hospital, Lebanese American University, School of Medicine, Lebanon; Center for Evidence-Based Anatomy, Sport & Orthopedics Research, Lebanon
| | - Joeffroy Otayek
- Department of Orthopedic Surgery, Lebanese American University Medical Center-Rizk Hospital, Lebanese American University, School of Medicine, Lebanon
| | - Jimmy Daher
- Department of Orthopedic Surgery, Lebanese American University Medical Center-Rizk Hospital, Lebanese American University, School of Medicine, Lebanon; Center for Evidence-Based Anatomy, Sport & Orthopedics Research, Lebanon
| | - Chahine Assi
- Department of Orthopedic Surgery, Lebanese American University Medical Center-Rizk Hospital, Lebanese American University, School of Medicine, Lebanon; Center for Evidence-Based Anatomy, Sport & Orthopedics Research, Lebanon
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Kendal A, Loizou C, Down B, McNally M. Long-Term Follow-up of Complex Calcaneal Osteomyelitis Treated With Modified Gaenslen Approach. FOOT & ANKLE ORTHOPAEDICS 2022; 7:24730114221133391. [PMID: 36329689 PMCID: PMC9623373 DOI: 10.1177/24730114221133391] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Background The treatment of chronic calcaneal osteomyelitis is a challenging and increasing problem because of the high prevalence of diabetes mellitus and operative fixation of heel fractures. In 1931, Gaenslen reported treatment of hematogenous calcaneal osteomyelitis by surgical excision through a midline, sagittal plantar incision. We have refined this approach to allow successful healing and early mobilization in a modern series of complex patients with hematogenous, diabetic, and postsurgical osteomyelitis. Methods Twenty-eight patients (mean age 54.6 years, range 20-94) with Cierny-Mader stage IIIB chronic calcaneal osteomyelitis were treated with sagittal incision and calcaneal osteotomy, excision of infected bone, and wound closure. All patients received antibiotics for at least 6 weeks, and bone defects were filled with an antibiotic carrier in 20 patients. Patients were followed for a mean of 31 months (SD 25.4). Primary outcome measures were recurrence of calcaneal osteomyelitis and below-knee amputation. Secondary outcome measures included 30-day postoperative mortality and complications, duration of postoperative inpatient stay, footwear adaptions, mobility, and use of walking aids. Results All 28 patients had failed previous medical and surgical treatment. Eighteen patients (64%) had significant comorbidities. The commonest causes of infection were diabetes ± ulceration (11 patients), fracture-related infection (4 patients), pressure ulceration, hematogenous spread, and penetrating soft tissue trauma. The overall recurrence rate of calcaneal osteomyelitis was 18% (5 patients) over the follow-up period, of which 2 patients (7%) required a below-knee amputation. Eighteen patients (64%) had a foot that comfortably fitted into a normal shoe with a custom insole. A further 6 patients (21%) required a custom-made shoe, and only 3 patients required a custom-made boot. Conclusion Our results show that a repurposed Gaenslen calcanectomy is simple, safe, and effective in treating this difficult condition in a patient group with significant local and systemic comorbidities. Level of Evidence Level III, case series.
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Affiliation(s)
- Adrian Kendal
- Nuffield Orthopaedic Centre, Oxford,
UK,Botnar Research Centre, The Nuffield
Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, Oxford,
UK,Adrian Kendal, MA, BMBCh, DPhil, FRCS,
Botnar Research Centre, The Nuffield Department of Orthopaedics, Rheumatology
and Musculoskeletal Sciences, Windmill Road, Oxford, OX3 7LD, UK.
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Evidence-based conservative limb preserving surgery for the diabetic foot complications: A systematic review of systematic reviews. Foot Ankle Surg 2022; 28:670-679. [PMID: 34479784 DOI: 10.1016/j.fas.2021.08.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2021] [Revised: 08/17/2021] [Accepted: 08/21/2021] [Indexed: 02/04/2023]
Abstract
BACKGROUND Limb preserving surgery for the treatment of diabetic foot complications (DFC) has been shown to yield excellent results and better outcomes when compared to non-surgical standard of care. The quality of the articles reporting the results of limb preserving surgery in treating DFC is quite low. The aim of this study was to evaluate the published systematic reviews and meta-analyses that looked at the efficacy of limb preserving surgery in treating DFC. METHODS PubMed, Cochrane Library and Google Scholar were searched for all systematic reviews and meta-analyses on limb preserving surgery in DFC. The Joanna Briggs Institute (JBI) critical appraisal tool for systematic reviews was used to appraise studies' quality. RESULTS 22 systematic reviews and meta-analyses with a total of 10,559 patients met the inclusion criteria. Five reviews reported on surgical treatment of diabetic Charcot, 5 reviews on bony procedures and 12 reviews on soft tissue procedures for treating DFU. The results of each review were reported. The vast majority of the studies were of Level IV of evidence. The mean JBI score was 9.82. CONCLUSIONS There is an underuse of the available limb preserving operations for the treatment of DFC despite excellent results and variety of procedures available in the literature, especially for Charcot neuroarthropathy and diabetic foot and toe ulcers.
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Choi Y. Rehabilitation of patients after diabetic foot amputation. JOURNAL OF THE KOREAN MEDICAL ASSOCIATION 2021. [DOI: 10.5124/jkma.2021.64.8.537] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Background: Diabetic foot is a diabetes-related complication that often requires amputation due to ulcer, necrosis, infection, and wound healing problems. Amputation decreases ambulation ability and worsens the patient’s general condition. Thus, active gait training is important after amputation.Current Concepts: The level of amputation depends on the anatomical position, for example, toe amputation and transfemoral amputation. The impairment of ambulatory function is also determined by the position of amputation. Continuous rehabilitation exercise is encouraged for ambulation before surgery. Wound management and pain control are needed for early rehabilitation exercise after surgery. The maturation of the amputation stump is especially important and needed for prosthesis wearing. If the general condition of the patient permits, muscle strengthening exercises, joint range of motion exercises, and ambulation exercises should be started as soon as possible.Discussion and Conclusion: Sufficient understanding of functional decline after amputation is required. The clear goal of ambulation should be set in consideration of the patient’s general condition and ability to walk before surgery. The ultimate goal of amputation is not only to remove necrosis, ulcers, and infected tissues but also to restore ambulatory function. Thus, expertise and significant effort before and after surgery are required.
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Ghioldi ME, Dealbera ED, Chemes LN, Caballero GA, Del Vecchio JJ. Cryptococcus neoformans osteomyelitis of the calcaneus: Case report and literature review. SAGE Open Med Case Rep 2021; 9:2050313X211027094. [PMID: 34350000 PMCID: PMC8287342 DOI: 10.1177/2050313x211027094] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2021] [Accepted: 06/02/2021] [Indexed: 12/03/2022] Open
Abstract
Cryptococcus neoformans is an encapsulated, yeast-like fungus
that can cause a systemic mycosis, particularly in immunocompromised patients.
Disseminated infections typically affect the central nervous system, and osseous
lesions are infrequent. Only 5%–10% of disseminated cryptococcosis involves
bones. A 69-year-old female presented pain, swelling, and a soft tissue mass in
her right lateral hindfoot. Her medical history included a kidney transplant
(10 years earlier) secondary to chronic disease due to IgA nephropathy. The
patient underwent an excisional biopsy, surgical debridement, and secondarily
negative pressure wound therapy to achieve skin closure. Biopsy revealed a rare
Cryptococcus neoformans osteomyelitis of the calcaneus. The
patient then received IV treatment with liposomal amphotericin B at 3 mg/kg/d
for 25 days. In conclusion, we present a case of cryptococcal osteomyelitis
which, although not a frequent disease, must be considered as one of the
differential diagnoses of osteolytic osseous lesions in patients with chronic
osteomyelitis. Cryptococcus neoformans may be a potential cause
of below-knee infection, mainly in immunocompromised patients.
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Affiliation(s)
- Mauricio Esteban Ghioldi
- Foot and Ankle Section, Orthopaedics Department, Fundación Favaloro-Hospital Universitario, Ciudad Autónoma de Buenos Aires (CABA), Argentine
| | - Eric Daniel Dealbera
- Foot and Ankle Section, Orthopaedics Department, Fundación Favaloro-Hospital Universitario, Ciudad Autónoma de Buenos Aires (CABA), Argentine
| | - Lucas Nicolás Chemes
- Foot and Ankle Section, Orthopaedics Department, Fundación Favaloro-Hospital Universitario, Ciudad Autónoma de Buenos Aires (CABA), Argentine
| | - Gustavo Alejandro Caballero
- Pathology Department, Fundación Favaloro-Hospital Universitario, Ciudad Autónoma de Buenos Aires (CABA), Argentine
| | - Jorge Javier Del Vecchio
- Foot and Ankle Section, Orthopaedics Department, Fundación Favaloro-Hospital Universitario, Ciudad Autónoma de Buenos Aires (CABA), Argentine.,Department of Kinesiology and Physiatry, Universidad Favaloro, Ciudad Autónoma de Buenos Aires (CABA), Argentine.,GRECMIP-MIFAS (Groupe de Recherche et d'Etude en Chirurgie Mini-Invasive du Pied-Minimally Invasive Foot and Ankle Society), Merignac, France
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