A systematic approach to the failed plastic surgical reconstruction of the diabetic foot

Plastic reconstruction for diabetic foot wounds must be approached carefully and follow sound micro-surgical principles as it relates to the anatomy of the designated flap chosen for coverage. First, the surgeon always needs to evaluate the local and general conditions of the presenting pathology and patient, respectively when considering a flap for reconstruction. The flap that is chosen is based on the vascularity, location, and size of the defect. Salvage of the failed flap and revisional reconstructive procedures are very challenging. Often, adjunctive therapies such as hyperbaric oxygen, negative pressure wound therapy, vasodilators, and/or vascular surgery is required. In certain case scenarios, such as patients with poor general health and compromised local vascularity in which revisional flap coverage cannot be performed, the above mentioned adjunctive therapies could be used as a primary treatment to potentially salvage a failing flap

Reverse flow digital artery pedicle flap for closure of diabetic forefoot ulceration

Digital artery pedicle flap is a useful surgical technique for coverage of plantar foot defects. For diabetic forefoot ulcers that are subject to recurrence despite consistent care, this flap can provide long-term durable closure. The authors provide a case report and overview of this innovative reconstructive procedure

The role of an extended medial column arthrodesis for Charcot midfoot neuroarthropathy

The etiology of diabetic Charcot neuroarthropathy involving the midfoot often includes an inciting traumatic event or repetitive micro-trauma from an uncompensated biomechanical imbalance that potentiates an incompletely understood pathway leading to a rocker-bottom foot deformity and ulceration. In the setting of a severe Charcot foot fracture and/or dislocation with obvious osseous instability, diagnostic delay can potentiate the limb-threatening sequelae of infected midfoot ulcerations in this patient population. In this article, the authors discuss the thought process as well as the advantages of performing an extended medial column arthrodesis for selected Charcot midfoot deformities

Diabetic foot infections: a team-oriented review of medical and surgical management

As the domestic and international incidence of diabetes and metabolic syndrome continues to rise, health care providers need to continue improving management of the long-term complications of the disease. Emergency department visits and hospital admissions for diabetic foot infections are increasingly commonplace, and a like-minded multidisciplinary team approach is needed to optimize patient care. Early recognition of severe infections, medical stabilization, appropriate antibiotic selection, early surgical intervention, and strategic plans for delayed reconstruction are crucial components of managing diabetic foot infections. The authors review initial medical and surgical management and staged surgical reconstruction of diabetic foot infections in the inpatient setting

Complications following surgical management of Haglund's triad: A retrospective, single-center analysis

Background: Haglund's triad consists of Haglund's deformity, insertional Achilles tendinosis, and retrocalcaneal bursitis and is most commonly managed surgically through Haglund's resection, bursectomy, and Achilles tendon detachment-reattachment using a central tendon-splitting approach stabilized with a double row suture construct. This procedure has demonstrated consistently good outcomes; however, we have anecdotally identified a higher complication rate performing this surgery compared with the published literature. Accordingly, we sought to evaluate this further. Methods: We performed a retrospective electronic medical record review of 44 consecutive patients (10 men, 34 women) who underwent surgical correction of Haglund's triad. Patient age, gender, laterality, body mass index, follow-up duration, complications encountered, and revision surgery performed were analyzed. Results: Significant differences were identified for gender and incidence of complications (p = 0.01424), with women having a greater incidence of complications than men and duration of follow-up (p = 0.0432) where women endured a longer follow-up period. No other significant differences for complications were identified for age (p = 0.192), laterality (p = 0.5535), or body mass index (p = 0.9532) irrespective of gender. Complications occurred in 50 % of patients with most complications persisting at the final follow-up. Conclusion: We identified a significantly greater incidence of complications for women compared to men for operative management of Haglund's triad regardless of age, laterality, or body mass index. Further analysis of the effect gender has on operative management of Haglund's triad seems warranted so that measures to mitigate complications can be developed, especially since complications persisted for those patients who encountered them which negatively affected their outcomes. Level of Evidence: III-Therapeutic study: Retrospective comparative analysis at a single institution Category: Rearfoot and Ankle Reconstructio