EXPERIMENTAL RESEARCHES UPON VASOMOTRICITY

Utilization of advanced modalities in the management of diabetic Charcot neuroarthropathy

Technological advances have allowed reconstructive foot and ankle surgeons greater opportunity to provide significant limb salvage options to those patients who present with significant lower extremity deformity due to diabetic Charcot neuroarthropathy. Paradigms that promote the utilization of these advanced modalities have demonstrated significant improved limb salvage outcomes in this challenging patient population and have consequently improved the quality of life for patients. The purpose of this review is to discuss current concepts in Charcot reconstruction.

Charcot arthropathy of the foot and ankle: modern concepts and management review

Charcot arthropathy (Charcot neuroarthropathy, diabetic neuropathic osteoarthropathy, or neuropathic arthropathy) remains a poorly understood disease, although recent research has improved our level of knowledge regarding its etiology and treatment. The effects of Charcot arthropathy are almost exclusively seen in the foot and ankle, and the diagnosis is commonly missed upon initial presentation. It has been well established that this complication of diabetes mellitus severely reduces the overall quality of life and dramatically increases the morbidity and mortality of patients. However, there are few high-level evidence studies to support management and treatment options at this point in time. The goal of this study is to evaluate the modern concepts of Charcot arthropathy through a review of the available literature and to integrate a perspective of management from the authors' extensive experience.

Recovery of vasomotor response in human spinal cord transection

Vasomotor responses of the skin of the thumb and the big toe were measured in normal subjects and patients with spinal transection at a neutral ambient temperature of 22.0 +/- 0.5 degrees C, and in a cool (12.0 +/- 0.5 degrees C) and warm (32.0 +/- 0.5 degrees C) environment. The vasomotor response of the hand and foot to the cooling and warming of part of the opposite upper or lower extremity was also recorded. Spinal transection at T5-11 abolishes acutely all vasomotor responses in the paraplegic lower extremities, but does not alter the responses in the upper extremities. By 4 months, the vasomotor tone in the lower extremities at a neutral ambient temperature returned to normal values as did the response to a cool and warm environment. The crossed vasomotor reflex to cooling and warming one lower extremity recovers more slowly, requiring a period of 18 months for complete recovery. The slower recovery of the vasomotor reflex in spinally transected man than in similarly treated dogs is though to be due to the greater spinal shock in the former. The recovery of vasomotor responses in the paraplegic limbs to cooling and warming after thoracic transections suggests that these responses are primitive and powerful thermoregulatory mechanisms.