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Background:
The scope of podiatric practice has changed significantly in the past couple of decades. Despite the increased quality of training, many people outside of podiatry may not realize what our scope of practice entails.
Methods:
We conducted a survey consisting of 10 items and asked internal medicine residents at Rush University Medical Center and patients whether they would feel comfortable consulting podiatrists, or being treated for each issue.
Results:
The results for residents are as follows: 1) toenail fungus, 35% yes and 65% no; 2) diabetic wound care, 87.5% yes and 12.5% no; 3) bunion surgery, 90% yes and 10% no; 4) ankle fracture surgery, 25% yes and 75% no; 5) calcaneal fracture surgery, 50% yes and 50% no; 6) tarsal tunnel nerve surgery, 62.5% yes and 37.5% no; 7) lower extremity arterial bypass, 5% yes and 95% no; 8) below-knee amputation, 5% yes and 95% no; 9) transmetatarsal amputation, 67.5% yes and 32.5% no; and 10) venous stasis wound care, 65% yes and 35% no. The results for patients are as follows: 1) toenail fungus, 72.5% yes and 27.5% no; 2) diabetic wound care, 70% yes and 30% no; 3) bunion surgery, 62.5% yes and 37.5% no; 4) ankle fracture surgery, 57.5% yes and 42.5% no; 5) calcaneal fracture surgery, 55% yes and 45% no; 6) tarsal tunnel nerve surgery, 50% yes and 50% no; 7) lower extremity arterial bypass, 32.5% yes and 67.5% no; 8) below-knee amputation, 27.5% yes and 72.5% no; 9) transmetatarsal amputation, 52.5% yes and 47.5% no; and 10) venous stasis wound care, 32.5% yes and 67.5% no.
Conclusions:
Internal medicine residents and patients do not have an accurate perception of the scope of podiatric medicine. This proves that, as a profession, we need to raise awareness about what the podiatric scope of medicine actually entails.
Background: Transmetatarsal amputation (TMA) is a viable option to avoid major amputation and limb loss in patients with forefoot sepsis, infection, or tissue loss. However, TMAs are associated with a significant incidence of dehiscence, readmission, and reoperation rates ranging from 26% to 63%. To encourage tissue healing, neovascularization, and durable closure, a nonwoven, resorbable, synthetic hybrid-scale fiber matrix whose architecture is similar to native human extracellular matrix was used in an augmented closure technique. We comparatively evaluated clinical outcomes and complication rates in TMA procedures with and without augmented closure.
Methods: A retrospective analysis of ten patients who underwent TMA with augmented closure using the synthetic matrix and ten patients who underwent TMA with standard primary closure was conducted.
Results: After TMA, 80% of the patients who underwent augmented closure demonstrated complete wound healing compared with 60% of the control group. Patients undergoing augmented closure demonstrated five instances of wound dehiscence and 20% limb loss compared with eight instances of wound dehiscence and 40% limb loss in the control group. After TMA and augmented closure, patients required eight interventional procedures before complete healing compared with patients undergoing standard closure, who required 13 interventional procedures before complete healing.
Conclusions: Augmented closure of surgical wounds after TMA using a synthetic hybrid-scale fiber matrix provided a unique means of reducing time to healing (18%), wound dehiscence (29%), number of procedures performed (39%), and rate of limb loss (20%). Augmented closure, therefore, offers a means of improving quality of life and reducing risk for patients undergoing TMA, and potentially reducing total cost of care.
Background:
Diabetic foot wounds remain a significant health-care issue. Healing these wounds in a timely manner is of paramount importance because the duration of ulceration correlates with increased rates of infection and amputation, costing billions of dollars yearly. Collagen-based matrices have been used as wound covers and have been shown to improve and expedite healing. We present our experience with equine pericardium biomatrix for the treatment of neuropathic foot wounds.
Methods:
Thirty-four patients with 37 diabetic foot wounds were evaluated at two institutions prospectively. All of the wounds were debrided, and equine pericardium biomatrix was applied. Secondary dressings were changed every 48 to 72 hours until healed or for 12 weeks after application. Healing rate at 12 weeks, time to wound closure, and complications were evaluated.
Results:
Twenty-two men and 12 women (mean age, 56.9 years) were treated and evaluated. Mean and median wound sizes at initial treatment were 715.8 and 440 mm2, respectively. The overall wound healing rate by 12 weeks was 75.7% (n =28). Mean and median times to wound closure were 7.2 and 7.0 weeks, respectively. No device or procedure-related complications were reported.
Conclusions:
The use of equine pericardium as a temporary biological scaffold is safe and effective for the treatment of chronic neuropathic foot wounds. (J Am Podiatr Med Assoc 102(5): 352–358, 2012)
