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1.  Adventitious Bursae Underlying Chronic Wounds: Another Possible Deterrent to Healing 
Eplasty  2012;12:e14.
Adventitious bursae typically develop in areas of chronic frictional irritation, usually under bony prominences. Although adventitious bursae are generally well understood, there is a paucity of data on effects of bursae underlying chronic wounds in neuropathic patients. This manuscripts reviews 4 clinical cases, each with a neuropathic patient with adventitious bursae underlying chronic nonhealing wound and strategies for treatment.
PMCID: PMC3286309  PMID: 22389747
2.  FaceTime for Physicians: Using Real Time Mobile Phone–Based Videoconferencing to Augment Diagnosis and Care in Telemedicine 
Eplasty  2011;11:e23.
Objective/Background: Telemedicine has, even in its infancy, had an impact on the provision of healthcare, particularly in rural communities. However, this often relies on an expensive and ponderous infrastructure that reduces the rapid use and spontaneity for consultations. Methods: Using postoperative and intraoperative examples, we describe the use of one rapid and widely available technology (iPhone FaceTime, Cupertino, California). Results: The device, in allowing “one button connection” similar to making a phone call, reduced the need for preplanning that is generally required for real-time telemedicine consultation. Conclusions: The ability to communicate quickly with something that is an afterthought has the potential to alter how we work with our colleagues and patients. Just as with the iPod in music and the laptop in computing, it is not the change in technology, but the change in form factor and ubiquity that alters this landscape.
PMCID: PMC3087505  PMID: 21559249
3.  Partial Calcanectomy in High-Risk Patients With Diabetes: Use and Utility of a “Hurricane” Incisional Approach 
Eplasty  2010;10:e17.
Introduction: Plantar heel ulcers in people with diabetes represent a difficult challenge to the treating physician. They become even more difficult with underlying osteomyelitis. When this infection is in the calcaneus it typically results in a partial or total calcanectomy or even more frequently, high-level amputation. Methods: In this article, we describe a novel serpentine incisional approach to the plantar and (if necessary) posterior heel allowing for ample exposure and facilitating closure predominantly along relaxed skin tension lines. Results: We present several representative case examples in which a hurricane incision has been used to treat and provide closure to plantar-based calcaneal ulcers. Discussion: The use of this incision, which resembles a satellite view of a hurricane, was successful in achieving a desired partial calcanectomy and wound closure. This may be an additional tool in the armamentarium of the surgeon to assist in healing and amputation prevention.
PMCID: PMC2817571  PMID: 20165545
4.  Wound Chemotherapy by the Use of Negative Pressure Wound Therapy and Infusion 
Eplasty  2010;10:e9.
Introduction: Although the use of negative pressure wound therapy (NPWT) is broadly efficacious, it may foster some potentially adverse complications. This is particularly true in patients with diabetes who have a wound colonized with aerobic organisms. Traditional antiseptics have been proven useful to combat such bacteria but require removal of some NPWT devices to be effective. Methods: In this article, we describe a method of “wound chemotherapy” by combining NPWT and a continuous infusion of Dakins' 0.5% solution either as a standardized technique in one device (ITI Sved) or as a modification of standard technique in another (KCI VAC) NPWT device. The twin goals of both techniques are to effectively reduce bacterial burden and to promote progressive wound healing. Results: We present several representative case examples of our provisional experience with continuous streaming therapy through 2 foam-based negative pressure devices. Discussion: Wound chemotherapy was successfully applied to patients with diabetes, without adverse reactions, complications, or recolonization during the course of treatment. We believe this to be a promising method to derive the benefits of NPWT without the frequent adverse sequela of wound colonization.
PMCID: PMC2806786  PMID: 20090841
5.  A Method of External Fixation to Offload and Protect the Foot Following Reconstruction in High-Risk Patients: The SALSAstand 
Eplasty  2009;9:e21.
Introduction: The course of wound healing in high-risk patients with diabetes, particularly those with peripheral arterial disease and renal failure, is often prolonged and fraught with complications. Traditional methods of offloading the posterior foot or holding correction in place following diabetic foot reconstruction include various padded and bolstering devices. Methods: In this article, we describe a method (SALSAstand) to effectively elevate, offload, and protect the foot with an external fixation device, while also promoting flap healing, maintaining tendon correction, and limiting the tendon retraction and contracture that is commonly seen following a foot-salvage procedure in high-risk patients. Results: Not applicable. Discussion: The SALSAstand device has been successfully utilized on many patients in our service to accomplish the aforementioned goals in this most challenging patient population.
PMCID: PMC2697004  PMID: 19578534
6.  The Diabetic Rapid Response Acute Foot Team: 7 Essential Skills for Targeted Limb Salvage 
Eplasty  2009;9:e15.
Objective: People with diabetes are prone to develop lower-extremity ulcerations and infections, both of which serve as major risk factors for limb amputation. The development of lower-extremity complications of diabetes is associated with increased morbidity and mortality. Recently, there has been increasing interest in the development of interdisciplinary teams to manage the myriad factors that complicate the treatment of high-risk patients, particularly in the perihospitalization period. Methods: This article presents 7 essential skills that necessarily allow the limb salvage team to appropriately manage the most common presenting comorbidities in patients with diabetes, including vasculopathy, infection, and deformity. Results: Seven essentials skills have been demonstrated to promote the greatest salvage outcomes, and these are the ability to (1) perform hemodynamic and anatomic vascular assessment with revascularization, as necessary; (2) perform neurologic workup; (3) perform site-appropriate culture technique; (4) perform wound assessment and staging/grading of infection and ischemia; (5) perform site-specific bedside and intraoperative incision and debridement; (6) initiate and modify culture-specific and patient-appropriate antibiotic therapy; and (7) perform appropriate postoperative monitoring to reduce risk of reulceration and infection. Conclusions: Utilization of these 7 essential skills as the core basis for interdisciplinary limb salvage team models will provide clinicians guidance when establishing such teams. Interdisciplinary teams have been demonstrated to improve quality and efficiency of patient care, thus improving overall outcomes and reducing amputation rates.
PMCID: PMC2680239  PMID: 19436764

Results 1-6 (6)