Volume 20 - Issue 3 - March 2007
Diabetes Watch »
Although the patient with diabetes and renal failure presents serious challenges to the limb salvage team, there is evidence and argument to support aggressive treatment and attempted limb salvage in a multidisciplinary clinical environment. An abundance of medical literature discusses the separate wound care challenges posed by diabetes and renal failure.
Less work has been done, however, to identify proper treatment and salvage techniques for patients who suffer from both maladies. While many do opt for primary amputation in the patient with diab
Wound Care Q&A »
When it comes to patients with ischemic foot ulcers, potential complications can be dire. Accordingly, it is important to have a firm grasp on diagnostic studies as well as current and emerging treatment options that may enhance outcomes for patients.
With this in mind, our expert panelists discuss a range of issues related to the ischemic foot.
Q: How do you approach/work up the ischemic foot ulcer patient?
A: David E. Allie, MD, works up such patients “very, very aggressively.” Of the approxi
Surgical Pearls »
Practitioners have described various osteotomies for the proximal hallux. However, the Akin closing wedge osteotomy is currently the most common procedure. Podiatric surgeons commonly employ the transverse plane closing wedge osteotomy for the correction of hallux abductus interphalangous deformity. One may also use this as an additional procedure for the correction of hallux abductovalgus deformity.
Akin noted that one should perform the closing base wedge osteotomy at the proximal one-third of the proximal hallux and orient it in the transverse p
Patients with diabetes can be a quite an undertaking for any physician who manages them on a consistent basis. In the past, this has created reservations when it comes to managing these patients especially from a surgical standpoint. However, over the years, with greater understanding of the disease, improvements in surgical techniques and emerging research, the reservations have diminished and the role of surgical management is a viable option when it comes to successfully treating those with diabetic ulcerations, infections and other related complications that exist in t
Feature » MRSA
Yes. By Guy R. Pupp, DPM, FACFAS, and Mark A. Kachan, DPM. Given the increasing incidence of methicillin-resistant Staphylococcus aureus, one should consider empiric coverage against MRSA in high-risk patients with infected ulcerations in the lower extremity.
The most common pathogens in nosocomial skin and skin structure infections in the United States and Canada in 2000 were Staph aureus. Researchers have stated that approximately 30 to 60 percent of all Staph aureus isolates are methicillin-resistant Staph aureus (MR
The neuropathic foot presents unique challenges when treating and preventing chronic wounds. One of the most difficult challenges is offloading the neuropathic foot without compromising function or causing a transfer of pressure that leads to further ulceration. When performing a limb salvage procedure, the goal is to provide the patient with a stable, plantargrade foot while still allowing for ambulation.1
In choosing the appropriate procedure to offload the foot, it is important to consider minimal bone resection versus a partial pedal
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