Volume 19 - Issue 9 - September 2006
Diabetes Watch »
Charcot’s arthropathy is a devastating complication of diabetes mellitus that frequently leads to permanent disability, ulceration and amputation. It is a rapidly progressive and severe form of arthritis. Researchers have equated the acute Charcot foot to a medical emergency since therapies are available that may alter its natural history.1 Unfortunately, the pathophysiology and development are poorly understood. This is frequently complicated by a delay in diagnosis until bony destruction is visible on plain radiographs. This delay often leads to worse outcome
Wound Care Q&A »
Bioengineered alternative tissues, or skin substitutes, can lead to success in patients with wounds that have not responded well to other modalities. Accordingly, our expert panelists offer a closer look at where these products fit into the wound healing armamentarium and share pertinent pearls from their clinical experience with these products.
Q: What skin substitutes do you utilize in treating lower extremity wounds?
A: Paul Kim, DPM, has had success using Apligraf® (Organogenesis) for more superficial chronic wounds. He cautions practitioners that it may take multipl
Surgical Pearls »
Foot and ankle surgeons have no shortage of choices when it comes to selecting instruments for surgical procedures. Our surgical team has found success in using the Koby line of instruments (OsteoMed) for the treatment of various conditions.
For the last four years, surgeons have found success using Koby instruments for three procedures commonly performed in the foot and ankle. Koby instruments are designed to perform the partial plantar fasciotomy for heel spur syndrome, intermetatarsal ligament decompression of neuroma and release of the gastrocnemius
The balance between technology and clinical practice is difficult to obtain. In the past, technology lagged far behind. Innovative thought and technique was stymied by the inability to develop practical instrumentation and implants. In recent years, however, the opposite effect has occurred. New materials and devices have inundated the marketplace. While these devices have been demonstrated to be safe, they are not necessarily any more efficacious and are certainly more costly than existing products.
Indeed, practitioners must be vigilant in evaluating t
Wound healing is a process that involves the stages of coagulation, inflammation, cell proliferation and repair of the matrix, epithelialization and remodeling of the scar tissue. These stages overlap and the entire process can last for months.1
During the post-injury coagulation phase, platelets initiate the wound healing process by releasing a number of soluble mediators including platelet-derived growth factor (PDGF), insulin-like growth factor-1 (IGF-1), epidermal growth factor (EGF), fibroblast growth factor (FGF), and transforming growt
Surgeons have traditionally relied upon autografts, replacement bone from sources within the patient’s own body, as the gold standard for graft remodeling in bone fracture and primary osseous repair. While autograft bone is superior in its ability to provide osteogenic mesenchymal stem cells (MSCs), it has the inherent problem of limited supply and morbidity associated with harvesting from donor sites. Given these limitations, there has been a need for orthobiologic bone substitutes and these products continue to emerge and evolve as viable graft alternatives.
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