Adult ; Bone and Bones ; diagnostic imaging ; injuries ; Femoral Fractures ; surgery ; therapy ; Foot Deformities, Acquired ; diagnosis ; etiology ; therapy ; Fracture Fixation, Intramedullary ; adverse effects ; methods ; Fractures, Ununited ; diagnostic imaging ; etiology ; surgery ; Humans ; Intra-Articular Fractures ; diagnostic imaging ; surgery ; Male ; Radiography ; methods ; Reoperation ; methods ; Treatment Outcome

PURPOSE: Negative pressure wound therapy (NPWT) is an adjunct therapy using negative pressure to remove fluid from open wounds through a sealed dressing and a specialized tubing that is connected to a collection container. NPWT is suitable for acute and chronic wound condition because it was designed to accelerate granulation formation on deep wound. Therefore, we performed this study to assess the effectiveness of NPWT for various wound condition in burn center. METHODS: We enrolled 17 patients who were treated with NPWT from January 2014 to April 2016. We analyzed the characteristics and outcomes of the patients through retrospectively. RESULTS: Among 17 patients, there were 13 patients for contact burn, 2 patients for electrical injury, 1 patient for diabetic foot ulcer and 1 patient for Flame burn. Most of the contact burn victims were injured by the exposure of relatively low temperature for a long time and some of them were injured under the condition of sensory deterioration including spinal cord injury, diabetes or sedatives. Wound coverage was accomplished by split thickness skin graft (STSG) in 12 patients. Local flap was done in 1 patient. STSG with local flap was done in 3 patients. And there were 1 patient who got a conservative management. The duration of NPWT application was from 8 days to 101 days (average 36.2 days). CONCLUSION: NPWT showed good clinical outcomes under various wound condition. Therefore, we think that it can be a new treatment paradigm for difficult wound management in burn center.
Bandages ; Burn Units* ; Burns* ; Diabetic Foot ; Humans ; Hypnotics and Sedatives ; Negative-Pressure Wound Therapy* ; Retrospective Studies ; Skin ; Spinal Cord Injuries ; Transplants ; Ulcer ; Wound Healing ; Wounds and Injuries

PURPOSE: The purpose of this study is to evaluate clinical outcomes and complications after fasciotomy in acute compartment syndrome. MATERIALS AND METHODS: Seventeen cases diagnosed as compartment syndrome and underwent fasciotomy from January 2011 to February 2015 were evaluated retrospectively. We investigated the causes and regions of acute compartment syndrome, the methods of wound management, the necessity of skin graft, and the complications including amputation and infection. RESULTS: According to the causes of acute compartment syndrome, there were 7 fractures, 1 traumatic hematoma, 6 reperfusion injury, and 3 rhabdomyolysis. The regions of acute compartment syndrome were 3 cases of thigh, 10 cases of leg, and 3 cases of foot. One case had acute compartment syndrome involving thigh, leg, and foot. Of 17 cases, 3 cases died due to reperfusion injury and one case with severe necrosis of soft tissues underwent amputation. Among the 13 cases excluding 4 cases with death or amputation, 3 cases underwent split thickness skin graft. Shoelace technique and/or vacuum-assisted closure (VAC) was used for 9 cases, and wound closure without skin graft was achieved in all except one case, while 2 cases required skin graft among 4 cases without shoelace technique or VAC. There were 2 cases of infection. CONCLUSION: Acute compartment syndrome caused by reperfusion injury had poor outcomes. Shoelace technique and/or VAC were useful for management of wound after fasciotomy.
Amputation ; Compartment Syndromes* ; Foot ; Hematoma ; Leg ; Necrosis ; Negative-Pressure Wound Therapy ; Reperfusion Injury ; Retrospective Studies ; Rhabdomyolysis ; Skin ; Thigh ; Transplants ; Wounds and Injuries

Adult ; Age Factors ; Aged ; Aged, 80 and over ; Amputation ; economics ; Cerebrovascular Disorders ; epidemiology ; Cohort Studies ; Comorbidity ; Conservative Treatment ; Costs and Cost Analysis ; Diabetes Mellitus ; economics ; Diabetic Foot ; economics ; epidemiology ; therapy ; Female ; Foot Deformities, Acquired ; economics ; epidemiology ; therapy ; Foot Injuries ; economics ; epidemiology ; therapy ; Health Care Costs ; Hospitalization ; economics ; Humans ; Hypertension ; epidemiology ; Joint Diseases ; economics ; epidemiology ; therapy ; Length of Stay ; economics ; Logistic Models ; Male ; Middle Aged ; Multivariate Analysis ; Myocardial Ischemia ; epidemiology ; Peripheral Vascular Diseases ; epidemiology ; Retrospective Studies ; Singapore ; epidemiology ; Wound Infection ; economics ; epidemiology ; therapy ; Young Adult

Skeletal tuberculosis developing after trauma is a rare occurrence.We report a rare case of posttraumatic tubercular osteomyelitis of mid-tarsal bone of the right foot. Patient was treated with regular dressing and anti-tubercular drugs. Posttraumatic skeletal tuberculosis should be considered in patient with non-healing ulcer.
Adolescent ; Foot Diseases ; etiology ; therapy ; Foot Injuries ; complications ; Humans ; Male ; Osteomyelitis ; etiology ; therapy ; Tuberculosis, Osteoarticular ; etiology ; therapy

BACKGROUND: Buddy taping is a well known and useful method for treating sprains, dislocations, and other injuries of the fingers or toes. However, the authors have often seen complications associated with buddy taping such as necrosis of the skin, infections, loss of fixation, and limited joint motion. To our knowledge, there are no studies regarding the complications of buddy taping. The purpose of this study was to report the current consensus on treating finger and toe injuries and complications of buddy taping by using a specifically designed questionnaire. METHODS: A questionnaire was designed for this study, which was regarding whether the subjects were prescribed buddy taping to treat finger and toe injuries, reasons for not using it, in what step of injury treatment it was use, indications, complications, kinds of tape for fixation, and special methods for preventing skin injury. Fifty-five surgeons agreed to participate in the study and the survey was performed in a direct interview manner at the annual meetings of the Korean Pediatric Orthopedic Association and Korean Society for Surgery of the Hand, in 2012. RESULTS: Forty-eight surgeons (87%) used buddy taping to treat finger and toe injuries, especially proximal interphalangeal (PIP) injuries of the hand, finger fractures, toe fractures, metacarpophalangeal injuries of the hand, and PIP injuries of the foot. Sixty-five percent of the surgeons experienced low compliance. Forty-five percent of the surgeons observed skin injuries on the adhesive area of the tape, and skin injuries between the injured finger and healthy finger were observed by 45% of the surgeons. CONCLUSIONS: This study sheds light on the current consensus and complications of buddy taping among physicians. Low compliance and skin injury should be considered when the clinician treats finger and toe injuries by using buddy taping.
Adult ; Finger Injuries/*therapy ; Foot Injuries/*therapy ; *Fracture Fixation/adverse effects/methods ; Humans ; Middle Aged ; Physicians/statistics & numerical data ; Questionnaires ; Splints/*adverse effects ; Surgical Tape ; Toes/*injuries

BACKGROUND: Negative-pressure wound therapy (NPWT) is believed to accelerate wound healing by altering wound microvascular blood flow. Although many studies using laser Doppler have found that NPWT increases perfusion, recent work using other modalities has demonstrated that perfusion is reduced. The purpose of this study was to investigate the influence of NPWT on tissue oxygenation of the foot, which is the most sensitive region of the body to ischemia. METHODS: Transcutaneous partial pressure of oxygen (TcpO2) was used to determine perfusion beneath NPWT dressings of 10 healthy feet. The sensor was placed on the tarso-metatarsal area of the foot and the NPWT dressing was placed above the sensor. TcpO2 was measured until it reached a steady plateau state. The readings obtained at the suction-on period were compared with the initial baseline (pre-suction) readings. RESULTS: TcpO2 decreased significantly immediately after applying NPWT, but gradually increased over time until reaching a steady plateau state. The decrease in TcpO2 from baseline to the steady state was 2.9 to 13.9 mm Hg (mean, 9.3+/-3.6 mm Hg; 13.5+/-5.8%; P<0.01). All feet reached a plateau within 20 to 65 minutes after suction was applied. CONCLUSIONS: NPWT significantly decrease tissue oxygenation of the foot by 2.9 to 13.9 mm Hg. NPWT should be used with caution on feet that do not have adequate tissue oxygenation for wound healing.
Bandages ; Blood Gas Monitoring, Transcutaneous ; Foot* ; Ischemia ; Negative-Pressure Wound Therapy* ; Oxygen* ; Partial Pressure ; Perfusion ; Reading ; Suction ; Wound Healing ; Wounds and Injuries

No abstract available.
Aged ; Anti-Infective Agents/therapeutic use ; Drug Therapy, Combination ; Foot Injuries/*complications ; Humans ; Male ; Muscle Relaxants, Central/therapeutic use ; Tetanus/diagnosis/drug therapy/*microbiology ; Tetanus Toxoid/therapeutic use ; Treatment Outcome ; Trismus/diagnosis/drug therapy/*microbiology ; Wounds, Stab/*complications

PURPOSE: Frostbite can affect people involved in winter sports, homeless and soldiers. It results in tissue necrosis from direct cellular damage and indirect damage secondary to vasospasm and the progressive microvascular thrombosis following reperfusion of the ischemic limb. However, the frostbite is under-estimated by the physicians. We describe the assessment and management of frostbite and identify the challenges of managing these complex tissue injuries. METHODS: A retrospective analysis of 62 injuries (61 men, average age; 20.5 yo) was conducted between August 2009 to April 2011 in the burn center of AFCH. We sought to determine the demographic characteristics, identification of soft tissue injury, treatment and complications. RESULTS: The 62 were treated as outpatients (n=23, 37.1%) or inpatients (n=39, 62.9%). The superficial degree was 38 (61.3%), while 24 (38.7) have deep degree. The 47.4% of superficial and 87.5% of deep frostbite were admitted. The sites most prone to frostbite were feet (95.2%), followed by hands (27.4%). The toes had the more deep injuries. The 6 cases (9.7%) occurred in wet circumstances. They had suffered more deep injuries than dry circumstances (66.6% vs 35.8%). Thirteen (33.3%) of inpatients were transferred to center 14 days after exposure. The increased levels of isoenzymes did not present the degree of injuries. The bone scan was performed in 22 (56.4%) of inpatients at average 11.3 PFD. We believe it showed an excellent correlation with clinical course, though not confirmed statistically. The patient was treated with rapid rewarming (7; 11.3%), hydrotherapy (11; 17.7%), STSG (3; 12.5 of deep frostbite), berasil (14; 22.6%) and ibuprofen (5; 8.1%). The PGE1 was administered to 34 (87.2%) of inpatients for 8.8 days. We believe the effect of PGE1 to prevent amputations, though not confirmed in evidence base. The sequelae of 9 (23.1%) inpatients included of paresthesia (10.3%), LOM (10.3%), Raynaud's syndrome (7.7%) and hyperhydrois (2.6%). CONCLUSION: In a military context, health education of troops is necessary to avoid moisture circumstances and to protect from cold injuries. We need new guideline to recommend early rewarming and evacuation to specialized units so that the degree of frostbite can be alleviated and rate of complication can be lowered. We need new principles to use NSAIDs, pentoxifylline, antiprostaglandin agents and thrombolytic therapy in amelioration of tissue damage. Together with initial aids, use of radiological assessment, triple phase bone scanning, Duplex studies, Plethysmograpy and future advancements should allow for a more aggressive and active approach to the management of tissue viability. This information is only a primer and requires continuous updating to improve patient outcomes.
Alprostadil ; Amputation ; Anti-Inflammatory Agents, Non-Steroidal ; Burn Units ; Cold Temperature ; Extremities ; Foot ; Frostbite ; Hand ; Health Education ; Humans ; Hydrotherapy ; Ibuprofen ; Inpatients ; Isoenzymes ; Male ; Military Personnel ; Necrosis ; Outpatients ; Paresthesia ; Pentoxifylline ; Reperfusion ; Retrospective Studies ; Rewarming ; Soft Tissue Injuries ; Sports ; Thrombolytic Therapy ; Thrombosis ; Tissue Survival ; Toes

Skin necrosis of the foot, oedema and lymphangitis from stonefish (Synanceia verrucosa) sting are complications well known for a long time and with potential long-term sequelae. Literature reports of stonefish envenomation give no specific reference on soft tissue management and surgical reconstruction. This is the first report describing a case of foot stonefish envenomation treated by vacuum-assisted closure therapy as an easy to use, accessible and simple adjuvant tool for management of large soft tissue necrosis.
Animals ; Bites and Stings ; complications ; surgery ; Dermatologic Surgical Procedures ; Fishes, Poisonous ; Foot Injuries ; surgery ; Humans ; Lymphangitis ; etiology ; surgery ; Male ; Middle Aged ; Necrosis ; Negative-Pressure Wound Therapy ; Skin ; pathology ; Skin Transplantation