Dear collegues! Could I remove little (1x0,5 cm)dry plantar ulcer and close wound with sutures during reconstructive surgery of cold Sharcot foot (Shopart arthrodesis) or I have to wait complete ulcer healing?
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The concept of 'plantar tissue stress' in the diabetic foot
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Prevention of foot ulcers in the at-risk patient with diabetes
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Re: reconsrtructive Sharcot surgery/
You could excise and close the ulcer, but I would avoid doing an arthrodesis until it has healed.
Why not heal the ulcer first in a total contact cast or removable CAM walker, then do the arthrodesis later to lessen risk of infection?
Or how about removal of just the underlying exostosis and excision of the ulcer if the foot is relatively stable, before attempting arthrodesis?
LL -
Related threads:
Pamidronate infusion timing in Charcot Rx
Charcot's - the perils of procrastination
Bone stress as trigger in Charcot's foot
Surgey in active Charcot
Charcot foot and Bone re-modelling
Charcot's: farewell to the neurotrophic theory.
"Silent" bone stress injuries in the feet of diabetic patients -
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It is quite possible that correcting the charcot foot will allow the ulcer to heal faster .
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Surgical stabilization of nonplantigrade Charcot arthropathy of the midfoot.
Pinzur MS, Sostak J.
Am J Orthop. 2007 Jul;36(7):361-5.
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Neutral ring fixation for high-risk nonplantigrade charcot midfoot deformity.
Pinzur MS.
Foot Ankle Int. 2007 Sep;28(9):961-6.
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A Retrospective Analysis of 50 Consecutive Charcot Diabetic Salvage Reconstructions.
Grant WP, Garcia-Lavin SE, Sabo RT, Tam HS, Jerlin E.
J Foot Ankle Surg. 2009 January - February;48(1):30-38.
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Midtarsal Arthrodesis in the Treatment of Charcot Midfoot Arthropathy
V. James Sammarco, G. James Sammarco, Earl W. Walker, Jr. and Ronald P. Guiao
The Journal of Bone and Joint Surgery (American). 2009;91:80-91.
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What "charcot reconstructive" procedure are you planning?
Where is the ulcer relative to the bony pathology?
I would agree with LL and Dr. Kirby that it may be of value to the outcome of your reconstruction to go ahead and heal the ulcer first. The only point I might add is that if the ulcer is caused by, say, a subluxed Calcaneal Cuboid or other area that you are planning on fusing, then it may make more sense to correlate the fusion with a closure of the small ulcer (or just pack it if you are going apply a NWB cast anyway).
Steve -
It depends on variables such as (1) where ulcer is in relation to reconstruction, (2) what type of "reconstruction" is proposed- an arthrodesis, I assume, (3) post-operative plans (immobilization)
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it is much better to leave the ulcer unclosed but after good deridment and removal of all callus areas followed by total contact cast ,, we have much data regarding this work in correcting the charcot's foot.
thank you very much
abdulhakim Al-tamimi
General surgeon, diabetic foot interest
university of Aden , Yemen -
Can we predict outcome of surgical reconstruction of Charcot neuroarthropathy by dynamic plantar pressure assessment?-A proof of concept study.
Najafi B, Crews RT, Armstrong DG, Rogers LC, Aminian K, Wrobel J.
Gait Posture. 2009 Oct 15. [Epub ahead of print]
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Reconstructive surgery for Charcot foot : Long-term 5-year outcome.
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Beaming the Columns for Charcot Diabetic Foot Reconstruction: A Retrospective Analysis.
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J Foot Ankle Surg. 2011 Jan 22. [Epub ahead of print]
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German-Austrian consensus on operative treatment of Charcot neuroarthropathy: a Perspective by the Charcot task force of the German Association for Foot Surgery
Armin Koller, Ralph Springfeld, Gerald Engels, Raimund Fiedler, Ernst Orthner, Stefan Schrinner, Alexander Sikorski
Diabetic Foot & Ankle 2011, 2: 10207
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Long-term Follow-up of Tibiocalcaneal Arthrodesis in Diabetic Patients with Early Chronic Charcot Osteoarthropathy
Carlo M.F. Caravaggi et al
Journal of Foot and Ankle Surgery (in press)
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A new limb-salvaging technique for the treatment of late stage complicated Charcot foot deformity: Two-staged Boyd's operation.
Altindas M, Kilic A, Ceber M.
Foot Ankle Surg. 2012 Sep;18(3):190-4.
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Solid Bolt Fixation of the Medial Column in Charcot Midfoot Arthropathy
Martin Wiewiorski, MD, Tetsuro Yasui, MD, PhD, Matthias Miska, MD, Arno Frigg, MD, Victor Valderrabano,
Journal of Foot and Ankle Surgery (in press)
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Successful surgical reconstruction of severe hind foot Charcot deformity can be achieved by internal fixation in diabetic patients
MO Ahmed, Y Morar, M Edmonds and V Kavarthapu
J Bone Joint Surg Br 2012 vol. 94-B no. SUPP XXXIX 61
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The development of a neuropathic ankle following successful correction of non-plantigrade charcot foot deformity.
Pinzur MS.
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Early Results with Use of the Midfoot Fusion Bolt in Charcot Arthropathy
Benjamin D. Cullen, Glenn M. Weinraub, Gabriel Van Gompel
Journal of Foot and Ankle Surgery; Article in Press
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Intramedullary medial column support with the Midfoot Fusion Bolt (MFB) is not sufficient for osseous healing of arthrodesis in neuroosteoarthropathic feet
Anica Eschler et al
Injury Available online 1 November 2013
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Multidisciplinary Approach to Soft Tissue Reconstruction of the Diabetic Charcot Foot.
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Plast Reconstr Surg. 2014 Oct 29.
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Posterior Approach for Medial Column Beam Screw in Midfoot Charcot Reconstruction: Technique and Structures at Risk
Kyle S. Peterson, DPM, AACFAS, Christopher F. Hyer, DPM, MS, FACFAS
The Journal of Foot and Ankle Surgery; Articles in Press
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Hindfoot fusion for Charcot osteoarthropathy with a curved retrograde nail.
Pyrc J, Fuchs A, Zwipp H, Rammelt S.
Orthopade. 2014 Dec 19
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Outcome of one-stage correction of deformities of the ankle and hindfoot and fusion in Charcot neuroarthropathy using a retrograde intramedullary hindfoot arthrodesis nail
M. Siebachmeyer et al
Bone Joint J 2015;97-B:76–82.
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Surgical treatment of the Charcot foot : Long-term results and systematic review.
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Hindfoot Arthrodesis in Charcot Neuroarthropathy Utilizing a Subtalar Fusion Cup: A Case Report.
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Beaming for Charcot Foot Reconstruction
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Foot & Ankle International June 1, 2015
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The medial column Synthes Midfoot Fusion Bolt is associated with unacceptable rates of failure in corrective fusion for Charcot deformity: Results from a consecutive case series.
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Midtarsal Reconstructive Arthrodesis Using a Multi-Axial Correction Fixator in Charcot Midfoot Arthropathy
Takumi Matsumoto, Selene G. Parekh
Foot Ankle Spec June 29, 2015
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Combined Internal and External Fixation for Diabetic Charcot Reconstruction: A Retrospective Case Series
Kenneth W. Hegewald, DPM, AACFAS, Megan L. Wilder, DPM, Todd M. Chappell, DPM, Byron L. Hutchinson, DPM, FACFAS
Journal of Foot and Ankle Surgery; Article in Press
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Ostectomy and Medial Plantar Artery Flap Reconstruction for Charcot Foot Ulceration Involving the Midfoot
Tomoya Sato, MD, Shigeru Ichioka, MD, PhD
The Journal of Foot and Ankle Surgery; 16 July 2015
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Comparison of Complications for Internal and External Fixation for Charcot Reconstruction: A Systematic Review
Paul Dayton, DPM, MS, FACFAS, Mindi Feilmeier, DPM, FACFAS, Mitchell Thompson, BA, Paul Whitehouse, BS, Rachel A. Reimer, PhD
Jnl Foot Ankle Surgery; Article in Press
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Pin Tract Infection Following Correction of Charcot Foot With Static Circular Fixation
Elissa S. Finkler, MD; Christopher Kasia, BS; Ellen Kroin, MD; Victoria Davidson-Bell, NP; Adam P. Schiff, MD; Michael S. Pinzur, MD
Foot & Ankle International July 29, 2015
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Preliminary Results of Primary Gastrocnemius-Soleus Recession for Midfoot Charcot Arthropathy
J. Monroe Laborde et al
Foot Ankle Spec September 22, 2015
Page 1 of 3
<
The concept of 'plantar tissue stress' in the diabetic foot
|
Prevention of foot ulcers in the at-risk patient with diabetes
>
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