Full-thickness burn of the foot: successful treatment with Apligraf. A case report.

Burn wounds, although uncommon in the foot, present a uniquely challenging opportunity to physicians. The keys to successful management include a proper and specific initial evaluation of the burning agent, the location, the TBSA affected, and the depth. Ultimately, proper recognition and meticulous wound care with skin grafting, when necessary, bring about the desired results.

Articular cartilage transplantation. Current and future limitations and solutions.

The ultimate goal of replacing cartilage with a bioengineered graft, autologous graft, or allograft is to replace the damaged articulating surface with tissue containing the anatomical, biomechanical, and functional properties of native articular cartilage, which will have resultant satisfactory clinical outcome. For transplanted articular cartilage to obtain the original histologic arrangement of hyaline cartilage with secure incorporation into host tissue, progressive integrated multidisciplinary research must continue. Although autologous chondrocyte transplantation of the talus is not yet FDA approved, this technique may provide the surgeons with a cutting-edge method to treat patients with nondegenerative osteochondral lesions of the talus and possibly other articulating joints of the foot.

Bone grafting. Principles and applications in the lower extremity.

Bone grafting techniques have progressed in the twentieth century, leading to results that are more predictable. A complete understanding of the entire healing process has broadened indications while decreasing complications. Numerous possibilities are available to the foot and ankle surgeon for reconstruction or trauma scenarios.

Wound healing.

Wounds and wound healing have been studied in the medical arena for centuries, however, in recent decades new advances have emerged in this extensive field. Currently, the wound healing process is studied at the molecular level giving new insights to the physiological process of wound closure and the lack thereof. With development of new treatment modalities the potential for earlier wound closure and ultimately increased quality of life for chronic wound patients is emerging.

Tendon pathology in the foot. The use of corticosteroid injection therapy.

Corticosteroids have been used extensively in the practice of orthopedics and podiatry. It is the authors' opinion that the issue of corticosteroids and their effect on the healing of tendon pathology has not been addressed sufficiently or answered adequately. Few studies have used a well-controlled injury model.

Pentoxifylline. Adjunctive therapy in the treatment of pedal frostbite.

Frostbite injury to the extremities has the potential for disastrous effects. Prompt recognition and treatment are paramount. The use of Pentoxifylline to minimize tissue damage in the treatment of frostbite is a viable addition to the traditional therapy of rewarming soaks, pain management, and vesicle débridement.

Nerve injury associated with plantarflexion-inversion ankle sprains.

This article presents some of the less frequently described nerve pathologies associated with severe plantarflexion-inversion ankle sprains. It outlines the likely mechanisms of nerve injury, the typical presentations, and treatment possibilities. An anatomic review of the lower extremity, with emphasis on the neurologic structures, is also included to assist in understanding the mechanism and location of the nerve injury.

Malignant melanoma of the foot and ankle.

Malignant melanoma is a serious and devastating skin disease that podiatrists may be called upon to treat. It is pertinent that delays in diagnosis and treatment of malignant melanoma be avoided. Some of the topics discussed in this article are causes, clinical features, classification, and treatment of malignant melanoma, focusing on the foot and ankle.

Vancomycin-resistant Enterococci infected puncture wound to the foot. A case report.

Vancomycin is often administered empirically to patients with osteomyelitis, septic arthritis, septic throbophlebitis, infected burns, and cellulitis of the lower extremities when methicillin-resistant staphylococci are suspected, or when a staphylococcus organism is suspected in a penicillin-allergic patient. Physicians must be aware of the guidelines established regarding the use of Vancomycin to avoid bacterial resistance. Physicians also must be aware of the procedures that have been developed to help contain nasocomial outbreaks of Vancomycin-resistant Enterococci.

Physeal fractures of the ankle.

Because the distal tibia is the third most common physeal injury, being able to assess and treat such a fracture accurately is a skill worth enhancing. Many factors contribute to the outcome of physeal injuries, but the physician's general knowledge of the physis, ability to order the right diagnostic tests, and classify the fracture can be the determining factors of quality care.

Calcaneal fractures.

Proper treatment of calcaneal fractures requires complete knowledge of pathoanatomy, surgical experience, and an understanding of all possible complications; otherwise, a devastating disability will occur. Lowery and Calhoun stated, "Indeed, poor reduction may be worse than no reduction."

Pilon fractures of the distal tibia.

Pilon fractures are one of the most complicated injuries confronting the lower extremity traumatologist. When faced with the pilon fracture, the surgeon must adhere to the principles of anatomic reduction and rigid stabilization to achieve early range of motion. Open reduction and internal or external fixation or a combination of fixation techniques, expertly placed, ensure the best possible outcome with the least complications.

Osteochondral lesions of the talar dome. A comprehensive review with retrospective study.

The incidence of osteochondral lesions of the talus is increasing because of a greater awareness of this injury following ankle trauma. The treating physician should view the so-called simple ankle sprain as a potential for fractures of the talar dome, especially in patients who are recalcitrant to treatment. It has been the authors' experience that talar dome lesions respond well to arthrotomy with removal of the fracture fragment and subchondral drilling, and yield generally good results.

Malleolar fractures of the ankle. A comprehensive review.

Ankle injuries and associated malleolar fractures are common. The outcome of treatment depends on the treating physician's ability to properly identify the mechanism of injury and subsequently restore ankle function by accurate realignment of the normal ankle articulations. Particular attention must be paid to restoring the length and alignment of the fibula because it plays a major role in stabilizing the talar ankle component.

A new fixation technique for metatarsal fractures.

Intramedullary nail fixation is an excellent option for open reduction and internal fixation of metatarsal neck and shaft fractures. In the authors' experience, the reduction of these fractures with Steinmann pin fixation provided excellent stability, required minimal soft-tissue dissection, and allowed for preservation of the periosteal tissue. Minimal disruption to the periosteum protects the osteoprogenitor cells located in the cambium layer.

Gunshot wounds to the lower extremity. A comprehensive review.

A thorough knowledge of the mechanisms by which penetrating projectiles disrupt tissue can assist the physician in evaluating and treating the wound in a rational manner. Projectile mass, velocity, shape, construction, and the characteristics and anatomic constraints of the tissue penetrated determine the amount, type, and location of tissue disruption. The possibility of additional injuries caused by secondary missiles and cavitation must be understood to distinguish between conservative versus surgical care of the patient.

Evaluation and surgical management of the arthritic midfoot secondary to rheumatic disease.

RA is a common disorder that has significant destructive effects on the midfoot portion of the foot. When these degenerative joint changes occur, any motion at the involved joints causes severe pain and disability, and limits the patient in his or her attempt to perform daily activities. These changes have a significant social and economic impact, and cause unwanted lifestyle changes.

Low-molecular-weight heparin for the treatment of deep vein thrombosis.

Low-molecular-weight heparin has been studied for the treatment of deep vein thrombosis in the inpatient setting and more recently in the outpatient setting. It is as safe and effective as unfractionated heparin and is effective when administered subcutaneously once or twice a day. Its bioavailability nears 100% and it has a longer half-life than unfractionated heparin, resulting in a prolonged anticoagulant effect.

Cigarette smoking and bone healing: implications in foot and ankle surgery.

Despite the known health risks associated with cigarettes, millions of Americans continue to smoke. Much has been reported on the adverse effects of cigarette smoke on wound healing. Recent experimental work and clinical observation have demonstrated the risk of impaired bone healing associated with cigarette smoking.

From crisis to success. Turning around a family practice residency program.

On Match Day in 1991, Broadlawns Medical Center in Des Moines, Iowa, learned that no residents had matched for the family practice residency program. In the 1992 match, the medical center filled all its residency positions, and repeated the success in the 1993 and 1994 matches. Broadlawns affected this impressively rapid turnaround through a strong commitment to bring its program to a level competitive with leading family practice residency programs, substantive changes to the structure and curriculum of the program, and significant expenditures of time, resources and personal energy.

Preterm birth prevention.

The prevention of preterm birth may be the most important problem facing maternity care providers. Preterm birth occurs in 10% of all births in the United States and is associated with 83% of perinatal deaths not caused by congenital anomalies. This article reviews the anatomy and physiology of the uterus, the physiology of uterine contractions, the initiation of labor, the etiology of preterm labor, risk factors and risk scoring for preterm labor, and the diagnosis and management of preterm labor.

Clozapine shows promise in schizophrenia treatment.

Clozapine represents the first significant advance in the pharmacotherapy of schizophrenia since development of phenothiazine antipsychotic drugs in the 1950s and 60s, yet only about 10% of potential patients nationwide are taking the medication.

Rupture of a rudimentary horn pregnancy with a combined intrauterine pregnancy. A case report.

In the first reported case of a rudimentary horn pregnancy coexistent with an intrauterine pregnancy, the patient presented at 19 weeks' gestation with acute abdominal distress. A ruptured left rudimentary horn pregnancy was found at laparotomy. The rupture was repaired.

Cocaine and pregnant women: a hospital study.

How prevalent is cocaine use among pregnant women? This study of pregnant and newborn populations at Broadlawns Medical Center in Des Moines showed positive rates of 7.1% and 3.6%, respectively.

Impact of clinic based educational videotape on knowledge of AIDS in STD patients.

A case control intervention study was conducted on STD clinic patients to evaluate the effectiveness of videotape education about AIDS. A questionnaire containing 20 true or false type questions was administered to 50 study group participants before and after display of the videotape and to 50 control group participants who did not watch the tape. Before and after scores of each group were analyzed for statistical significance.