C Attinger

..The foot and ankle surgeon can then perform preoperative mapping of the arterial blood supply with the Doppler. By making the necessary adjustments to the planned incision, surgery can proceed safely with uneventful healing...

..This article focuses on the surgical implications of angiosomes of the foot and ankle and their arterial-arterial connections...

..Most importantly, by addressing the underlying bony pathologic findings, the recurrence rates were also drastically reduced...

..Our job as physicians is to match the correct solution to the patients' lifestyle and their medical, physical and psychological conditions so they can achieve their desired level of activity as quickly as possible...

..In addition, if studies confirm the validity and reliability of the proposed patient grading system discussed, it may help guide use of NPT in postsurgical patients...

..The beneficiaries include the patient with a healed wound, the physician with a gratifying practice, the health care system with lower costs, and the hospital with a steady influx of complex patients...

..Understanding the angiosomes of the foot and ankle and the interaction among their source arteries is clinically useful in surgery of the foot and ankle, especially in the presence of peripheral vascular disease...

..There is a growing body of evidence that can provide guidance on the appropriate use of such adjuvants in the problem wound. Several adjuvants are discussed, including growth factor, bioengineered tissues, and hyperbaric medicine...

..In this article, the authors examine whether skin graft coverage of the exposed Achilles tendon is a viable option for reconstruction and whether the comorbidity of diabetes affects the outcome...

..Local muscle flaps should remain on the forefront of possible reconstructive options when treating small foot and ankle wounds that have exposed bone, tendon, or joint...

..Subsequent healing then can be achieved by use of wound-healing adjuncts such as the V.A.C. device, hyperbaric oxygen, skin substitutes, growth factor, or plastic surgical techniques...

..The key to subsequently achieving high salvage rates is the quality of perioperative wound care (e.g., serial debridements, antibiotics, dressings) and the timing and selection of appropriate soft-tissue coverage...

..The VAC sometimes can convert a large wound to a smaller wound so that a local muscle flap can be used. This procedure takes time, however, and adds to the cost of the repair...

..The objective of this review is to provide surgeons with a baseline understanding of the processes of débridement in the noninfected wound...

..Although many factors must be considered in choosing the target artery for revascularization, consideration should be given to revascularization of the artery directly feeding the ischemic angiosome...

..Using microvascular reconstructive techniques, it can be performed successfully and with the majority of patients regaining an ambulatory status...

..VAC is generally well tolerated and, with few contraindications or complications, is fast becoming a mainstay of current wound care...

..The intended emphasis of this brief report is to provide the foot and ankle surgeon with an appreciation for the clinical vascular anatomy of the transmetatarsal amputation through a handheld Doppler examination...

..Finally, electrostimulation may be one of the up and coming therapies for the future. Though, more studies are needed to determine the mode of delivery for various types of wounds...

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..Little attention has been given to the role of peripheral nerve surgery as an early treatment option...

..In the properly selected patient population, external fixators serve as an indispensable adjunct to wound healing by providing temporary offloading or immobilization of joints...

..The authors used a novel approach to manage this difficult clinical situation, by addressing the sensory nerve supply to the affected wound region...

..The tools provided in this article will help expedite and clarify the decision-making process...

..Extracorporeal shock wave therapy (ESWT) may accelerate and improve wound repair. This study assesses the feasibility and safety of ESWT for acute and chronic soft-tissue wounds...

..A.C. Therapy? (11) How should success in the use of V.A.C. Therapy be defined? (12) How can one combine effective offloading and V.A.C. Therapy?..

..NPWT be discontinued in this population? 8) How should NPWT be used in combination with other modalities? 9) Should small, superficial, noninfected wounds be considered for NPWT? 10) How should we define success in future studies of NPWT?..

..Future studies will be directed toward determining the roles of prophylactic Achilles tendon lengthening preventing equinovarus deformities, possible plantar foot ulceration, and Charcot collapse...

..quot; Each year, new mediators are discovered and our understanding of inflammatory mediators and cellular interactions grows. This article will attempt to provide a concise overview on wound healing and wound management...

..The discussion will end with a pictorial essay summarizing the wound-healing process...

..It was'nt until the time of large armies using muskets and cannons that surgical wound care emerged again. This article will briefly highlight major milestones in wound care...