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Background: Reamputations are frequent after minor amputations performed for diabetic foot osteomyelitis (DFO). Whether the type of amputation is associated with a particular outcome is unknown. The aim of this study was to evaluate whether amputations of the transarticular compared with the transosseous type have different rates of clinical and microbiological failure., Methods: We actively followed 284 patients with DFO (543 episodes of minor foot amputations: 203 transarticular and 340 transosseous) for 1 year. We assessed the long-term effect of transarticular compared with transosseous amputations on the rates of clinical and microbiological failure using comparative statistics, log-rank survival analyses, Kaplan-Meier curves, and multivariate Cox regressions., Results: In 122 episodes (22.5%) there was clinical failure that led to reamputation. The difference in the risk of clinical failure of transarticular versus transosseous amputations was nonsignificant (44 [21.7%] versus 78 [22.9%]; Pearson χ2 test: P = .73). Similarly, the difference in microbiological failure (32 episodes, 5.9% overall) between groups was nonsignificant (11 [5.4%] and 21 [6.2%], respectively; P = .72). The mean time between the index surgery and clinical failure was 2.2 months for transarticular and 3.2 months for transosseous amputations (Mann-Whitney U test; P = .39). Survival analyses showed similar evolutions for each group (log-rank test; P = .85). In the multivariate Cox regression analysis, the type of amputation did not significantly influence clinical or microbiological failures., Conclusions: In DFO, there is no significant difference between transarticular and transosseous amputations within 1 year in the incidence of clinical or microbiological failures.

Background: As a consequence of improved survival rates after burn injury occupational reintegration of burn survivors has gained increasing significance. We aimed to develop a precise patient questionnaire as a tool to evaluate factors contributing to occupational reintegration., Material and Methods: A questionnaire comprising 20 questions specifically evaluating occupational reintegration was developed under psychological supervision. The single-center questionnaire study was implemented in patients with burn injuries who were admitted to the 6‑bed burn intensive care unit (BICU) of the General Hospital of Vienna, Austria (2004-2013). The questionnaire was sent to burn survivors of working age (18-60 years) with an abbreviated burn severity index (ABSI) of 6 or greater, a total burn surface area (TBSA) of 15% or greater, and a BICU stay of at least 24 h., Results: A total of 112 burn survivors met the inclusion criteria and were contacted by mail. Of the 112 patients 11 (10%) decided to participate in the study and 218/220 questions (99%) in 11 patients were answered. Out of 11 patients 7 (64%) reported successful return to work and 4 of 11 (36%) did not resume their occupation. Advanced age, longer BICU and hospital stays, higher TBSA, burn at work, lower education, and problems with esthetic appearance seemed to impair patients' return to their occupation., Conclusion: When implementing the questionnaire, severely burned patients with higher age, lower education, and longer hospital and BICU stay seemed at high risk for failed reintegration in their profession after burn injury.

Background:  Radical debridement and wound closure with vascularized flaps has become a standard procedure in the treatment of deep sternal wound infections. Negative pressure incision management systems have been proven to diminish wound infections after sternotomy. In this study, the utility of Prevena Incision Management System (KCI Licensing Inc.) was evaluated in obese patients who received unilateral pectoralis major flap for the treatment of deep sternal wound infections., Methods:  The outcome and wound-related complication rates of 19 obese patients (mean body mass index, 33.7) treated for deep sternal wound infection with pectoralis major muscle flap in combination with Prevena between 2011 and 2016 were compared with 28 obese patients treated with conventional wound dressing only between 2000 and 2010., Results:  In patients additionally treated with Prevena, significantly fewer surgical revisions due to wound-related complications were necessary as compared with patients who received conventional wound dressing (5.3 vs. 32.1%, p  = 0.034). A significantly shorter ICU length of stay (median 0 vs. 3.5 days, p  < 0.001) and a trend toward shorter length of hospitalization (median 14 vs. 19.5 days after pectoralis major flap) could be observed., Conclusion:  The application of Prevena significantly reduced revision surgery rates in obese patients treated with unilateral pectoralis major flap for deep sternal wound infections., Competing Interests: Disclosure The authors report no conflicts of interest in this work., (Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.)