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Functional Limb Salvage: The Multidisciplinary Team Approach

✍ Scribed by Christopher E. Attinger (editor), John S. Steinberg (editor)


Publisher
Springer
Year
2023
Tongue
English
Leaves
618
Category
Library

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✦ Synopsis


Taking a truly interdisciplinary approach to the topic, Functional Limb Salvage is a ready reference for all clinicians and surgeons treating this patient population, including plastic, vascular, orthopedic and podiatric surgeons and their support staff.

The content of this text is focused on defining and expanding upon the importance and, more specifically, the intricacies of the multidisciplinary team approach. Although this is often touched upon or cited as an integral aspect of care, there are only sparse descriptions of the interplay of multiple team members in concert with the care of this challenging patient population.

This comprehensive text opens with definitions, demographics, epidemiology, pathophysiology and etiology of the limb salvage patient population, whether due to infection, ischemia or deformity. The multidisciplinary team itself is then outlined, from the who, when and where of the intervention to the role of the individual clinicians themselves; from vascular and plastic surgeons to podiatric and orthopedic surgeons, multiple medical specialties, and with thorough attention to the integral support staff of NPs, PAs and many others. History and assessment are then discussed as a prelude to both conservative and surgical treatments, including wound healing optimization, orthotics and prosthetics, skin grafting, amputation, bioengineered tissue and more. A final chapter on innovation and landmark publications rounds out the presentation.

✦ Table of Contents


Foreword
Diabetes: The Twenty-First Century Epidemic
References
Preface
Contents
1: Building It from Scratch: The Team Approach to Functional Diabetic Limb Salvage
Background
The Multidisciplinary Team
Benefits of a Multidisciplinary Team Approach: A Global Perspective
Composition of the Team
Role of Team Members in Functional Diabetic Limb Salvage:
Wound Management Pathway: Multidisciplinary Framework
Pragmatics to Delivery: Ingredients for Success
Identifying the Patient with Multidisciplinary Needs
Location
Pearls for Practice: Wound Care in the Rural Setting
Team Communication
Barriers to Communication
Support from Above
Patient Centered Care and Role of the Patient
Conclusion
References
2: Staffing and Day-to-Day Management: The Nuts and Bolts of Running a Wound Care Center
Page 1: How Clinic Runs
Daily Operations, Center for Wound Healing (CWH)
Daily Operations, Hyperbaric Oxygen Therapy (HBOT)
Attendings/Residents Coverage
Operating Room (OR)
Page 2: CWH/HBOT Staffing Structure
Wound Center Staffing (Fig 2.1)
Page 3: Who Does What?
Leadership: Co-Managers
Nurse Manager Roles and Responsibilities
Page 4: Patient Services Manager Roles and Responsibilities:
Page 5: Why is Co-Management Important? Our Personal Perspectives
Page 6: Staffing Roles: Clinical
Clinical Associates
Nurse Practitioners (CWH)
Page 7: Staffing Roles: Administrative
Page 8: The Triage Desk
Page 9: What Makes for Triage Desk Success
Page 10: Scheduling
Clinic Master Calendar (Fig. 2.3)
Page 11: Scheduling
Outlook Master Calendar (Fig. 2.4)
Page 12: Scheduling
Provider and Orthotic/Prosthetic Coverage Template (Fig. 2.5)
Page 13: Scheduling
Upcoming Clinic Numbers (Fig. 2.6)
Page 14: Scheduling
Plans of the Day (Fig. 2.7)
Page 15: Scheduling
Clinical Staff Schedules (Fig. 2.8)
Page 16: Managerial Tracking of Clinic Operations
Page 17: Associate Engagement
Page 18: Leadership Philosophies: The Managers’ Perspectives
3: Case Management of the Complex Limb Salvage Admission
The Straightforward Discharge: The Amputee
Case
Plan
The Moderately Complex Discharge: The Free-Flap Patient
Background on Free Flaps
Case
Plan
The Complex Discharge
Case
Plan
Other Barriers
Hospital Administration and the Limb Service
Conclusion
4: Integrating Inpatient Care to Your Outpatient Wound Care Center: Key to Successful Patient Management
Introduction
Discharge Planning Begins on the Day of Admission
Multidisciplinary Discharge Rounds Promote Information Sharing
Communication Between All Services Is Critical
Antibiotic Therapy Requires Early Consideration
Provider Involvement Contributes to Successful Transitions
A One Page Snapshot of Each Admission Provides an Invaluable Bridge
Skillful Outpatient Clinic Care Furthers the Progress Made During an Inpatient Stay
Communication Between the NP Team and the Outpatient Clinic Staff Is Critical
Day-After-Discharge Calls Flag Problems
Well Managed Transitions Impact a Hospital’s Bottom Line
Conclusion
References
5: Diabetic Foot Ulcers by the Numbers: Epidemiology of Limb Salvage
Introduction
Prevalence and Scope of the Problem
Healthcare Costs of the Diabetic Foot
Amputation Versus Limb Salvage
Socioeconomic and Ethnic Disparities in Diabetic Foot Management
Mortality and Outcomes
References
6: Unlocking the Mystery of Peripheral Neuropathy in Diabetes
Introduction
Question: Why Should DPN Be a Mystery?
The Diabetic Neuropathies
Diagnosis of DPN
Neuropathy and the Pathway to Foot Ulceration
Treatment of DPN
Pharmacological Treatment
Conclusions
References
7: The Science and Utility of Offloading the Diabetic Foot
Introduction to Offloading and Its Utility
Biomechanics of the Diabetic Foot
Conservative (“External”) Methods of Offloading the Diabetic Foot
Felt Padding
Custom Accommodative Orthotics
Diabetic Shoes
Custom Shoes
Controlled Ankle Movement (CAM) Walker
Total Contact Cast (TCC)
Charcot Restraint Orthotic Walker: “CROW” Boot
Long-Term Bracing Options
Arizona Brace
Patellar Tendon Bracing
Surgical (“Internal”) Methods of Offloading the Diabetic Foot
Soft Tissue Procedures
Percutaneous Flexor Tenotomy
Tendoachilles Lengthening
Tendon Transfers
Bone Procedures
Modified Keller Resection Arthroplasty for First MPJ Ulcers Under Hallux
MIS Invasive Floating Metatarsal Osteotomy for Pressure Under Metatarsal Heads
Utility of External Fixation for Offloading
Offloading Options Categorized by Wound Location
References
8: Medical Management of the Limb Salvage Inpatient
Section 1: Perioperative Management of Cardiac Risk Factors and Disease
Estimate Risk
Risk of Procedure
Conditions That Confer Risk
Tools
Functional Capacity
Myocardial Injury After Noncardiac Surgery (MINS)
Preoperative Cardiac Testing
EKG
Transthoracic Echocardiography
Cardiac Stress Testing
Cardiac Catheterization/CTA
Cardiac Biomarkers
Optimizing Medical Therapies Preoperatively
Beta-Blocker
Aspirin
Statin/Lipid-Lowering
Ace-I/Arb
Summary of Cardiovascular Assessment
Section 2: Diabetes Management
Glucose Management
Hypoglycemia
Hyperglycemia
Goal Glucose Range
Antidiabetic Medications
Non-insulin Medications
Insulin
Perioperative Insulin Management
Preparation for Discharge
Education
Home Medication Management
Prevention of Atherosclerotic Disease
Goal Hemoglobin A1c Ranges
Follow-Up
Section 3: Anticoagulation and Antiplatelet Management
Background
Thrombotic Risk
Bleeding Risk
Anticoagulants
Warfarin
Direct Thrombin and Direct Xa Inhibitors
Antiplatelet Agents
Venous Thromboembolism (VTE) Prophylaxis
Summary of Anticoagulation
Section 4: Postoperative Complications
Acute Kidney Injury
Delirium
Postoperative GI Complications
Postoperative Nausea and Vomiting
Opioid Induced Constipation
Postoperative Ileus
Antibiotics Associated Diarrhea
Summary of Complications
Conclusion: Medical Management of the Limb Salvage Inpatient
References
9: Evaluation and Examination of the Diabetic Foot
Introduction
Simple Staging System
Classifications of the Diabetic Foot
History
Presenting Complaint (Be Aware That Some Patients May Be Asymptomatic Due to Neuropathy)
Assessment of Pain
Bilateral Neuropathic Pain
What Is the Nature of the Pain?
When Is the Pain Worse?
Where Is the Pain?
General Symptoms
Diabetic Neuropathic Cachexia
Acute Painful Neuropathy of Rapid Glycaemic Control
Acute Reversible Neuropathy
Painful Neuropathy of Impaired Glucose Tolerance
Unilateral Neuropathic Pain
Focal Nerves Affected in the Leg
Lateral Cutaneous Femoral Nerve of Thigh-Meralgia Paraesthetica
Posterior Tibial Nerve: Tarsal Tunnel Syndrome
Common Peroneal Nerve
Femoral Nerve
Saphenous Nerve
Lumbar Spinal Stenosis
Complex Regional Pain Syndrome
Bilateral ischaemic pain.
Other Causes of Bilateral Leg Pain
Unilateral Ischaemic Pain
Differentiation of Neuropathic Pain from Ischaemic Pain
Past Foot History
Diabetes History
Past Medical History
Drug History
Family History
Psychosocial History
Examination
Skin and Skin Breakdown
Skin
Colour of the Skin of Foot
Temperature of the Skin Foot
Skin Breakdown
Infection
Ischaemia
Critically Ischaemic Foot
Acute Ischaemia
Necrosis
Deformity (Including Limited Joint Mobility)
Pes Cavus
Trigger Toe
Hammer Toe
Claw Toes
Hallux Valgus
Fibrofatty Padding Depletion (FFPD)
Charcot Foot
Deformities Related to Previous Trauma and Surgery
Limited Joint Mobility (Including Hallux Rigidus)
Callus and Corns
Oedema
Unilateral Oedema
Bilateral Oedema
Nails
Structure of the Nails
Colour of the Nail Bed
Abnormalities Under the Nail
Nail Infections
Neuropathy
Motor Neuropathy
Autonomic Neuropathy
Sensory Neuropathy
Clinical Examination
Monofilaments Examination
Neurothesiometry
Examination of Painful Neuropathy
Gait
Footwear Assessment
Examination of Patient’s Footwear
Examination of Patient’s Socks
General Examination
Classification and Staging of the Diabetic Foot
Staging
Stage 1
Stage 2
Stage 3
Stage 4
Stage 5
Conclusion
References
10: Frailty and Mobility Degeneration in Diabetes and Diabetic Foot Ulceration
Aging, Diabetes, and Frailty
Pathways of Frailty in Diabetes
Frailty and Biomechanics of Lower Extremities
Mobility Degeneration in Diabetes and Diabetic Foot Ulceration
Screening Frailty
Frailty Phenotypes and Frailty Index
Emerging Technologies
The Impact of Frailty in Diabetes
Potential Solutions to Improve Outcomes Among Frail and Pre-frail Diabetic Patients
Conclusion
References
11: Anesthesia for the DLS Patient: Minimizing Risk and Maximizing Safety
Preoperative Optimization
Intraoperative Risk Mitigation
Postoperative Recovery Optimization
References
Further Reading
12: Debridement of the Diabetic Foot and Leg
Introduction
Wound Healing
Wound Bed Preparation
Types of Debridement
Mechanical
Enzymatic
Autolytic
Biologic
Surgical
Surgical Debridement
Indications
Instrumentation
Technique
Atraumatic Technique
Debridement of Skin
Debridement of Subcutaneous Tissue
Debridement of Deep Tissues
Debridement of Bone
Staged Approach
Save as Much Tissue as Possible Prior to Closure
Methylene Blue
Assessing Tissue Viability
Clinical Determination
Microbiological Determination
Conclusion
References
13: An Evidence-Based Approach to Treating Osteomyelitis
Introduction
Pathophysiology
Microbiology
Treatment
Surgical Treatment
Systemic Antibiotic Therapy
Route of Administration
Specific Agents
Duration of Therapy
Intra-osseus or Topical Antimicrobials
Outcome of Treatment
Key New Trends in Treating DFO
References
14: Practical Lessons Learned in Managing Diabetic Foot Infections
Introduction
The Initial Presentation
Management of the Diabetic Foot Infection
Conclusion
References
15: Managing Soft Tissue Infection in the Diabetic Foot: Cultures, Drugs, and Source Control
Soft Tissue Infection of the Diabetic Foot
Microbiology of the Diabetic Foot
Diagnosis of Soft Tissue Infections of the Diabetic Foot
Microbiological Assessment of Soft Tissue Infections of the Diabetic Foot
Biomarkers of Infection
Management of the Diabetic Foot Infection
Surgical Part of the Treatment of Infection
Antimicrobial Therapy
General Aspects
Antibiotics Useful for the Treatment of SST DFIs
Choice and Adaptation of the Antimicrobial Therapy
Biofilm and Soft Tissue Infections of the Diabetic Foot
Resolution of Infection
References
16: Surgical Management of Diabetic Foot Infection and Osteomyelitis
Introduction
Clinical Assessment and Classifications
Applied Anatomy of Diabetic Foot Infection
Principles of Surgical Debridement of Diabetic Foot Infections
Clean Margins in Surgical Treatment of DFO
Surgical Management of Forefoot Osteomyelitis
Surgical Treatment of Infected Heel Ulcers
Principles of Exostectomy
Surgical Management of Diabetic Foot Attack
Conclusion
References
17: Charcot Foot Syndrome: Aetiology and Diagnosis
The Bottom Line
Introduction
The Charcot Foot Is a Syndrome: Not a Disease
History
The Clinical Presentation of the Charcot Syndrome
Active Phase
Inactive Phase and Recurrence
Aetiology of the Charcot Syndrome
Aetiology: Predisposition
Neuropathy
Effect of Neuropathy on Bone
The RANK/RANKL-NFkappaB and Wnt/β-catenin Pathways
Effect of Neuropathy on the Joint Capsule
Effect of Neuropathy on the Vasculature
Additional Predisposing Factors Associated with Diabetes
Effects of Neuropathy on the Vasculature
Other Predisposing Factors in Diabetes
Skeletal Fragility in Diabetes
Chronic Renal Failure
Simultaneous Pancreas-Kidney Transplant (SPKT) in Type 1 Diabetes
Obesity
Genetic Predisposition
Aetiology: Permissive Factors
Aetiology: Precipitation
What Triggers the Onset of Inflammation at the Time That the Charcot Process Becomes Active?
Aetiology: Presentation
Changes in Pro-inflammatory Cytokine Expression When the Charcot Foot Syndrome Is Active
Effects of Clinically Overt Inflammation on Bone
Aetiology: Perpetuation
Studies on the Expression of Pro-inflammatory Cytokines During the Course of Active Charcot Syndrome
Resolution
Prognosis
Recurrence
Mortality
Footnote
Why Is the Charcot Syndrome So Uncommon?
Diagnosis of Active Disease
Diagnosis of Active Disease: Clinical
Diagnosis of Active Disease: Investigations
Imaging
Other Investigations
Diagnosis of Active Disease: Education of the Person with Diabetes
The Bottom Line
References
18: Charcot Foot: Conservative Management
Introduction
Charcot Foot with Fractures
Orthotic Treatment
Total Contact Cast (TCC)
Prefabricated Diabetic Walker (DW)
Charcot Restraint Orthotic Walker (CROW)
Frame Orthosis (FO)
Shoes
Monitoring
MRI
Conventional Radiography
Postoperative Follow-Up Treatment
References
19: Charcot Foot: Surgical Management and Reconstruction
Introduction
Controversies of Surgical Management
Radiographic Evaluation
Preoperative Evaluation
Charcot Bone
Indications for Surgery
Exostectomy
Reconstruction of Active Charcot Foot
Reconstruction of Inactive Charcot foot
Deformity Correction
Hindfoot and Midfoot Stabilization Using Internal Fixation
Hindfoot Internal Fixation
Midfoot Internal Fixation
Two-Stage Reconstruction
Postoperative Care of Reconstructed Charcot Foot
References
20: Diagnostic Evaluation of Arterial Disease in Limb Salvage
Introduction
History and Physical Examination
Noninvasive Perfusion Assessment
Noninvasive Diagnostic Imaging
Invasive Diagnostic Imaging
Therapeutic Options
Conclusion
References
21: Arterial Disease Management in the Limb Salvage Patient: Endovascular and Open Bypass
Introduction
Open Surgery General Considerations
Preoperative Surgical Considerations
Surgical Considerations: Inflow Operations
Surgical Considerations: Infrainguinal Bypass
Complications
Results
Choice of Surgical Revascularization or Endovascular Procedure
General Considerations in Endovascular Revascularization
Targets of Endovascular Revascularization
Anatomic Considerations in Endovascular Revascularization
Evaluation of the Collateral Vessel Network
Metabolic Demands of Tissue Loss
Multivessel Versus Single-Vessel Revascularization
Technical Approaches in Endovascular Revascularization
Chronic Total Occlusions (CTOs) Crossing Strategy
Endovascular Strategy in the Vascular Territories of the Lower Leg
Treatment of Inflow Disease: The Aortoiliac System
Treatment of Inflow Disease: The CFA
Treatment of Femoro-Popliteal (FP) Segment
Treatment of Below the Knee (BTK) Arteries
Treatment of Below the Ankle (BTA) Arteries
“No-Option” Patients with CLTI
Conclusion
22: Venous Disease Management in the Limb Salvage Patient: Diagnostics, Compression, and Ablation
Introduction
Anatomy
Normal Venous Valves
Pathophysiology
Epidemiology
Causes and Risk Factors
Clinical Presentation of Venous Hypertension
Diagnostic Workup
Economic Burden and Quality of Life
Conservative Management
Elevation
Compression Therapy
Treatment of Superficial Refluxing Veins
Thermal Endovenous Closure
Mechanochemical Endovenous Closure (MOCA)
Adhesive Endovenous Closure
Post-procedural Care
Complications
Treatment of Incompetent Perforator Veins
Treatment of Deep Venous Obstruction
Conclusion
References
23: Science and Practicality of Tissue Products in Limb Salvage
Introduction
Current Treatments
Tissue Product Definition
Science and Practicality of Allografts and Xenografts
Science and Practicality of Dermal Substitutes
Science and Practicality of Biosynthetic Dressings
Science and Practicality of Cultured Skin Grafts
Impact of Tissue Products for Diabetic Foot Wound Healing
Impact on Wound Healing
Impact on Limb Salvage
Financial Comparison
Conclusion
References
24: Limb Wounds of Dermatologic Disease: Dermatopathology, Biopsy, and Medical Management
Wound Differential
Autoimmune and Inflammatory Diseases
Pyoderma Gangrenosum
Maverakis Diagnostic Criteria [2]
Autoimmune Bullous Diseases of the Skin
Discoid Lupus Erythematosus
Opportunistic Infections
Atypical Mycobacterial Infection
Fungal Infections
Ecthyma Gangrenosum
Allergic Contact Dermatitis
Cutaneous Malignancy
Squamous Cell Carcinoma
Marjolin’s Ulcer
Vascular Diseases
Calciphylaxis
Vasculitis
Vasculopathies
Workup
Obtaining Specimens: Recommended Sites and Transport Media
Further Management
Pyoderma Gangrenosum
Atypical Mycobacterial Infection
Fungal Infection
Contact Dermatitis
Malignancy
Calciphylaxis
References
25: Prosthetics, Orthotics, and Amputation Rehabilitation
Collaboration with Medstar
Preventative Measures
Pre-amputation Consultation
Prosthetist Consultation
Peer Support
Amputee Care Coordinator
Traumatic Amputee
Immediate Post-operative Prosthetic Care
Preparatory Prosthesis
Definitive Prosthesis
Summary
References
26: Surgical Offloading, Tendon Balancing, and Prophylactic Surgery in Diabetic Limb Salvage
Introduction
Goals of Surgical Intervention
Imaging and Diagnostics Studies
Radiographs
Advanced Imaging
First Digit and Metatarsophalangeal Joint
First Metatarsophalangeal Joint Arthroplasty
Procedure
Lesser Digits and Metatarsophalangeal Joints
Percutaneous Flexor Tenotomy
Procedure
Lesser Digital Arthroplasty
Procedure
Lesser Metatarsal Head Osteotomies
Procedure
Use of Functional Antibiotic Spacers
Osseous Midfoot Deformity
Midfoot Exostectomy
Procedure
Osseous Midfoot Reconstruction
Procedure
Osseous Rearfoot and Ankle Deformity
Tibiotalocalcaneal Arthrodesis
Procedure
Pantalar Arthrodesis
Procedure
Adjunctive Procedures
Talectomy
Supramalleolar Osteotomy
Soft Tissue and Tendon Balancing Procedures
Tendon Lengthening
Tendo-Achilles Lengthening (TAL)
Procedure
Gastrocnemius Recession (GR) and Gastrocnemius-Soleus Recession (GSR)
Procedure
Tendon Transfers
Anterior Tibial Tendon Transfer
Procedure
Split Tibialis Anterior Tendon Transfer
Procedure
Posterior Tibial Tendon Transfer
Procedure
External Fixation for Surgical Offloading
Prophylactic Surgery in Limb Salvage
Summary
References
27: Negative Pressure Wound Therapy
Introduction
Mechanism of Action
Indications
Chronic Wounds
Closed Incisions
Infected/Contaminated Wounds
Innovation
Foam
Drape
Portability
Remote Monitoring
Conclusion
References
28: Hyperbaric Oxygen Therapy in Functional Limb Salvage
Introduction
Hyperbaric Physiology
HBO and Limb Salvage
HBO and Diabetic Foot Ulcerations
HBO and Compromised Skin Grafts and Flaps
HBO in Clinical Practice
Adverse Effects of HBO
Topical Oxygen Therapy
Conclusions
References
29: Skin Grafting
Introduction
Categories of Skin Grafting
Split-Thickness Skin Grafts
Full-Thickness Skin Grafts
Skin Graft Healing
Pathologies Treated
Diabetic Foot Ulcers
Peripheral Arterial Disease
Presurgical Evaluation
Evaluation of Vascular Supply
Infection Control
Other Considerations
Operative Techniques
Wound Bed Debridement
STSG Harvesting
STSG Application
Postoperative Healing
Donor Site Healing
Recipient Site Healing
Complications and Revisions
Factors Impairing Healing
Revisional Procedures
Conclusion
References
30: Local Flaps for Reconstruction and Limb Salvage of the Foot and Ankle
Introduction to Local Flap Reconstruction of the Foot
Abductor Digiti Minimi Muscle Flap
Anatomy
Surgical Technique
Abductor Hallucis Muscle Flap
Anatomy
Surgical Technique
Extensor Digitorum Brevis Muscle Flap
Anatomy
Surgical Technique
Flexor Digitorum Brevis Muscle Flap
Anatomy
Surgical Technique
First Dorsal Metatarsal Artery Flap
Anatomy
Surgical Technique
Lateral Calcaneal Artery Skin Flap
Anatomy
Surgical Technique
Medial Plantar Artery
Anatomy
Surgical Technique
Reverse Sural Artery Flap
Anatomy
Surgical Technique
Fillet Flap of Toe
Anatomy
Surgical Technique
Random Skin Flaps
Tissue Expansion
Conclusion
References
31: Free Tissue Transfer in Diabetic Limb Salvage: Lessons Learned and Best Practices for Functional Salvage
Introduction
Indications
Preoperative Evaluation and Optimization
Medicine
Vascular
Podiatric and Orthopedic Surgery
Surgical
Intraoperative Optimization
Anesthesia
Flap Choice
Vessel Anastomosis
Flap Inset
Postoperative Optimization
Flap Monitoring
Conclusion
References
32: Advanced Plastic Surgical Reconstruction Options in the Lower Extremity
Introduction
Patient Population and Selection
Pre-operative Surgical Evaluation
Preoperative Counseling
Preoperative History
Preoperative Examination
Preoperative Studies
Preoperative Consultations
Preparation for Reconstruction
Algorithmic Approach to Reconstruction
Types of Wounds and Defect-Specific Considerations
Forefoot Wounds
Midfoot Wounds
Hindfoot Wounds
Ankle Wounds
Massive Wounds
Recipient Vessel Selection
Flap Selection
Technical Considerations and Adjuncts to Improve Outcomes
Wound Preparation
Recipient Vessel Selection
Flap Planning
Incision Planning
Use of the Tourniquet
Anastomosis
Use of Flow-Through Flaps or “T-Shaped Anastomoses”
Bony Contouring and Biomechanical Correction
Use of Antibiotic Cements and Bone Void Fillers
Drains
Flap Inset
Anticoagulation
Postoperative Monitoring
Positioning
Compression
External Fixation
Hyperbaric Oxygen Therapy (HBOT)
Conclusions
References
33: Partial Foot Amputations: Technique and Outcomes
Introduction
Indications
General
Wound
Infection
Ischemia
Deformity
Partial Foot Amputations
General
Tissue Handling
Toe Amputation
Partial Ray Amputation
Transmetatarsal Amputation
Lisfranc’s Amputation
Chopart’s Amputation
Vertical Contour Calcanectomy Amputation
Conclusion
References
34: Below Knee Amputation: Techniques to Improve Rehabilitation, Pain Management, and Function
Introduction
Anatomy and Surgical Considerations
Morbidities Associated with BKA
Targeted Muscle Reinnervation and Regenerative Peripheral Nerve Interface Surgery for Neuroma Prevention and Treatment
Pharmacological Agents and Regional Analgesia
Opiate Analgesics
N-Methyl d-Aspartate (NMDA) Receptor Blocker
Gabapentinoids
Calcitonin
Non-steroidal Anti-inflammatory Drugs (NSAIDs)
Epidural Analgesia
Perineural Catheters
Psychological Treatment Modalities and Support Groups
Nutrition
Physical Therapy, Rehabilitation, and Patient Education
Prosthetics and Functional Scoring Scales
References
35: Complications and Revision Surgery in Complex Limb Salvage
Introduction
Complication Workup
History
Physical Examination
Imaging
Laboratory Studies
Complications
Lower Extremity Nonunion
Hypertrophic Nonunion
Example of Hypertrophic Nonunion
Atrophic Nonunion
Example of Atrophic Nonunion
Infected Nonunion
Example of Injected Nonunion
Example of Infected Ankle Arthrodesis Nonunion
Malunion
Example of Tibial Malunion in the Setting of Ankle Arthritis
Advanced Surgical Techniques and Troubleshooting in the Revision Setting
Problems
Obstacles
Example of a Case Involving a Midfoot Obstacle
Example of a Case Involving an Ankle Obstacle
Complications
Example of a Complication Based on the Paley Classification
Postoperative Management
Conclusion
References
36: Establishing and Running an Amputee Support Group to Empower Your Patients
Introduction
Importance of Support After Amputation
The Amputee Coalition
The Power of Peer Support
Establishing Your Own Amputee Support Group
References
37: Analyzing the Population Dynamics of Limb Salvage
Introduction
Disparities Faced by the Diabetic Foot Population
Geographical Location
Access to Care
Race and Ethnicity
Socioeconomic Status
Comorbidities
The Multidisciplinary Limb Salvage Team
The Future of Multidisciplinary Care
A Global Context
Care Delivery Optimization
Collaborative Initiatives
Conclusion
References
38: DLS Innovations: Landmark Publications and Innovations from Our Team
Evolution of Multidisciplinary Care
The Effect of Multidisciplinary Care on Amputations
Innovations in Lower Extremity Reconstruction
Policy Implications
References
Index


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Written and edited by leading international experts in the field, <i>Gastrointestinal Oncology: A Critical Multidisciplinary Team Approach</i> is an indispensable reference for clinicians, medical practitioners, and trainees involved in the investigation, diagnosis, and treatment of esophageal, gast

Limb Salvage of the Diabetic Foot: An In
✍ Michael E. Edmonds; Bauer E. Sumpio 📂 Library 📅 2019 🏛 Springer 🌐 English

This book provides a practical guide to the treatment of patients as risk from limb amputation. The most common presentations of the diabetic foot are presented in concise and evidence-based chapters covering the neuropathic foot, the Charcot foot, the ischemic foot, and the infected foot. Each sect