16 results on '"Chrzan JS"'
Search Results
2. A biomechanical model for the transmetatarsal amputation
- Author
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Chrzan, JS, primary, Giurini, JM, primary, and Hurchik, JM, primary
- Published
- 1993
- Full Text
- View/download PDF
3. Evaluation of a collagen-alginate wound dressing in the management of diabetic foot ulcers.
- Author
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Donaghue VM, Chrzan JS, Rosenblum BI, Giurini JM, Habershaw GM, and Veves A
- Subjects
- Adult, Aged, Aged, 80 and over, Female, Humans, Male, Middle Aged, Sodium Chloride therapeutic use, Wound Healing, Alginates therapeutic use, Bandages standards, Collagen therapeutic use, Diabetic Foot therapy
- Abstract
Efficacy and safety of a collagen-alginate topical wound dressing (FIBRACOL Collagen-Alginate Wound Dressing) in the treatment of diabetic foot ulcers was compared with that of regular gauze moistened with normal saline. Seventy-five patients with foot ulcers were assigned randomly in a 2:1 ratio to the collagen-alginate test dressing or the gauze dressing. At the end of the study, the mean percent reduction of the wound area was 80.6% +/- 6% in the collagen-alginate dressing group and 61.1% +/- 26% in the gauze dressing group (p = .4692). Thirty-nine (78%) patients treated with the collagen-alginate dressing achieved > or = 75% wound area reduction, compared with 15 (60%) of gauze-treated patients. Complete healing was achieved in 24 (48%) of the collagen-alginate dressing group and 9 (36%) of the gauze dressing group. Wound size, when averaged over the 8-week period and with the duration of the ulcer taken into account, was reduced significantly in the collagen-alginate dressing group, as compared with the gauze dressing group (df = 1, p = .0049). It is concluded that the collagen-alginate test dressing is as or more effective and safe as the currently used treatment.
- Published
- 1998
4. Endothelial dysfunction and the expression of endothelial nitric oxide synthetase in diabetic neuropathy, vascular disease, and foot ulceration.
- Author
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Veves A, Akbari CM, Primavera J, Donaghue VM, Zacharoulis D, Chrzan JS, DeGirolami U, LoGerfo FW, and Freeman R
- Subjects
- Acetylcholine, Adult, Aged, Biomarkers analysis, Biopsy, Cohort Studies, Diabetic Angiopathies enzymology, Diabetic Angiopathies pathology, Diabetic Foot enzymology, Diabetic Foot pathology, Diabetic Neuropathies enzymology, Diabetic Neuropathies pathology, Female, Gene Expression Regulation, Enzymologic, Humans, Iontophoresis statistics & numerical data, Male, Middle Aged, Nitroprusside, Reference Values, Skin pathology, Vasodilator Agents, Diabetic Angiopathies physiopathology, Diabetic Foot physiopathology, Diabetic Neuropathies physiopathology, Foot blood supply, Nitric Oxide Synthase analysis, Skin enzymology, Vasodilation physiology
- Abstract
We studied endothelial-mediated microvascular blood flow in neuropathic diabetic patients to determine the association between endothelial regulation of the microcirculation and the expression of endothelial constitutive nitric oxide synthetase (ecNOS) in the skin. Vasodilation on the dorsal foot in response to heating and iontophoresis of acetylcholine (endothelium-dependent) and sodium nitroprusside (endothelium-independent) were measured using single-point laser Doppler and laser Doppler imaging in diabetic patients with neuropathy (DN), with neuropathy and vascular disease (DI), with Charcot arthropathy (DA), and without complications (D), and in healthy control subjects (C). The response to heat was reduced in the DN (321 [21-629] percentage of increase over the baseline, median [interquartile range]) and DI (225 [122-470]) groups but was preserved in the DA (895 [359-1,229]), D (699 [466-1,029]), and C (810 [440-1,064], P < 0.0001) groups. The endothelial-mediated response to acetylcholine was reduced in the DN (17 [11-25]), DA (22 [2-34]), and DI (13 [2-30]) groups compared with the D (47 [24-58]) and C (44 [31-70], P < 0.001) groups. The non-endothelial-mediated response to sodium nitroprusside was also reduced in the DI (4 [0-18]), DN (17 [9-26]), and DA (21 [11-31]) groups compared with the D (37 [19-41]) and C (44 [26-67], P < 0.0001) groups. There was a significant reduction in vasodilation in the DI group compared with all other groups (P < 0.0001). Full thickness skin biopsies from the dorsum of the foot of 15 DN, 10 DI, and 11 C study subjects were immunostained with antiserum to human ecNOS, the functional endothelial marker GLUT1, and the anatomical endothelial marker von Willebrand factor. The staining intensity of ecNOS was reduced in both diabetic groups. No differences were found among the three groups in the staining intensity of von Willebrand factor and GLUT1. We conclude that the endothelium-dependent and endothelium-independent vasodilations are impaired in diabetic patients predisposed to foot ulceration and that neuropathy is the main factor associated with this abnormality. Reduced expression of ecNOS may be a major contributing factor for endothelial dysfunction. These data provide support for a close association of neuropathy and microcirculation in the pathogenesis of foot ulceration.
- Published
- 1998
- Full Text
- View/download PDF
5. Neuropathic ulcerations plantar to the lateral column in patients with Charcot foot deformity: a flexible approach to limb salvage.
- Author
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Rosenblum BI, Giurini JM, Miller LB, Chrzan JS, and Habershaw GM
- Subjects
- Adult, Aged, Chronic Disease, Diabetic Foot pathology, Foot pathology, Humans, Middle Aged, Postoperative Complications, Reoperation, Retrospective Studies, Surgical Flaps, Arthropathy, Neurogenic complications, Diabetic Foot etiology, Diabetic Foot surgery
- Abstract
Neuroarthropathy of the midfoot may lead to a structural deformity that predisposes the diabetic patient to skin breakdown and ulceration. In some cases, conservative management is not adequate, making surgical intervention necessary. The authors performed a retrospective study to look at those patients who required surgical intervention for a specific pattern of neuroarthropathy. Over a 2 1/2-year period, 32 feet (31 patients) underwent surgical procedures for treatment of nonhealing neuropathic ulcerations beneath the lateral column of Charcot feet. All feet underwent exostectomy with 17 undergoing excision of the ulcer with primary closure, 8 closure via rotational fasciocutaneous flap with transpositional intrinsic muscle flap, and 6 through an incision placed adjacent to the ulcer. One patient whose ulcer was healed at the time of surgery had the incision placed directly over the prominence. Overall, 29 of 32 feet maintained functional limb salvage. This included eight patients who required revisional surgery, either by resection of more bone or creation of a local flap for coverage. Life-table analysis resulted in an 89% overall success rate. The results show that a flexible approach to skin and soft tissue coverage is necessary to heal these patients, provided attention is directed to the underlying bony prominence.
- Published
- 1997
- Full Text
- View/download PDF
6. Longitudinal in-shoe foot pressure relief achieved by specially designed footwear in high risk diabetic patients.
- Author
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Donaghue VM, Sarnow MR, Giurini JM, Chrzan JS, Habershaw GM, and Veves A
- Subjects
- Adult, Aged, Diabetic Foot epidemiology, Disabled Persons, Female, Humans, Leg Ulcer epidemiology, Longitudinal Studies, Male, Middle Aged, Pressure, Risk Factors, Diabetes Mellitus, Type 1 physiopathology, Diabetes Mellitus, Type 2 physiopathology, Diabetic Foot prevention & control, Diabetic Neuropathies physiopathology, Leg Ulcer prevention & control, Orthotic Devices, Shoes
- Abstract
Specially designed Thor-Lo footwear has been shown to reduce the in-shoe foot pressures in diabetic patients at risk of foot ulceration when compared to their own footwear. Fifty at high risk patients 32 (64%) males, 17 (34%) type 1 diabetes) have been provided with this foot wear and have been followed up for 6 months. Mean age was 57.6 (range, 34-78) years, duration of diabetes 22.4 (range, 4-50) years, Neuropathy Symptom Score 3.36 +/- 2.96 (mean +/- S.D.), Neuropathy Disability Score 16.8 +/- 6.83, VPT 43.4 +/- 11.8 Volts while 43 (86%) could not feel a 5.07 or smaller Semmes-Weinstein monofilament. Forty-two (84%) patients were re-examined at an interim visit 3 months after baseline, while 37 (74%) completed the study. In-shoe peak forces and pressures were measured using the F-Scan system. No difference was found among the peak force among baseline (95.5 +/- 26 kg), interim (96.5 +/- 33) and final visit (97.7 +/- 25.2, P + NS). There was no difference in peak pressures at the baseline (3.98 +/- 1.42 kg.cm-2), second visit (4.13 +/- 2.30) and the final visit (4.25 +/- 1.51). Nine (18%) patients developed foot problems and one died during the study. We conclude that no changes in foot pressures were found over a period of 6 months of continuous usage of the specially designed footwear in a group of diabetic patients at risk of foot ulceration. Further prospective studies are required to evaluate the impact of specially designed footwear in reducing the rate of foot ulceration.
- Published
- 1996
- Full Text
- View/download PDF
7. Differences in joint mobility and foot pressures between black and white diabetic patients.
- Author
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Veves A, Sarnow MR, Giurini JM, Rosenblum BI, Lyons TE, Chrzan JS, and Habershaw GM
- Subjects
- Adult, Aged, Biomechanical Phenomena, Case-Control Studies, Diabetes Mellitus, Type 1 physiopathology, Diabetes Mellitus, Type 2 physiopathology, Diabetic Neuropathies epidemiology, Female, Foot Ulcer epidemiology, Humans, Male, Metacarpus, Metatarsus, Middle Aged, Pain, Pressure, Reference Values, Risk Factors, Shoes, Black People, Diabetes Mellitus physiopathology, Diabetic Foot epidemiology, Diabetic Neuropathies physiopathology, Foot, Joints physiology, Joints physiopathology, White People
- Abstract
Limited joint mobility is common in diabetes and is related to high foot pressures and foot ulceration. We have examined the differences in joint mobility and foot pressures in four groups matched for age, sex, and duration of diabetes: 31 white diabetic, 33 white non-diabetic, 24 black diabetic, and 22 non-diabetic black subjects. Joint mobility was assessed using a goniometer at the fifth metacarpal, first metatarsal, and subtalar joints. In-shoe and without shoes foot pressures were measured using an F-Scan system. Neuropathy was evaluated using clinical symptoms (Neuropathy Symptom Score), signs (Neuropathy Disability Score), and Vibration Perception Threshold. There was no difference between white and black diabetic patients in Neuropathy Symptom Score, Neuropathy Disability Score, and Vibration Perception Threshold. Subtalar joint mobility was significantly reduced in white diabetic patients (22 +/- 7 degrees) compared to white controls (26 +/- 4 degrees, black diabetic patients (25 +/- 5 degrees), and black controls (29 +/- 7 degrees), and increased in black controls compared to white controls and black diabetic patients (level of statistical significance p < 0.05). Without shoes foot pressures were higher in white diabetic patients (8.31 +/- 400 kg cm-2) compared to white controls (6.81 +/- 2.31 kg cma2), black diabetic patients (6.2 +/- 2.53 kg cm-2) and black controls (5.00 +/- 1.24 kg cm-2) and lower in black controls compared to white and black diabetic patients (p < 0.05 in all cases). We conclude that racial differences exist in joint mobility and foot pressures between black and white subjects.(ABSTRACT TRUNCATED AT 250 WORDS)
- Published
- 1995
- Full Text
- View/download PDF
8. Preventing loss of the great toe with the hallux interphalangeal joint arthroplasty.
- Author
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Rosenblum BI, Giurini JM, Chrzan JS, and Habershaw GM
- Subjects
- Adult, Aged, Aged, 80 and over, Chronic Disease, Diabetes Mellitus, Type 1 surgery, Diabetic Foot surgery, Diabetic Neuropathies surgery, Female, Follow-Up Studies, Humans, Male, Middle Aged, Recurrence, Treatment Failure, Wound Healing, Arthroplasty adverse effects, Arthroplasty methods, Foot Ulcer surgery, Hallux surgery, Toe Joint surgery
- Abstract
Chronic ulcerations of the hallux may result in amputation if infection becomes uncontrolled. Salvage of the hallux often requires surgical intervention when conservative measures fail. Many authors have described various procedures to prevent recurrent ulceration and the potential for loss of the great toe. The authors have reviewed their experience with the hallux interphalangeal joint arthroplasty for chronic neuropathic ulcers of the great toe. Between August 1988 and July 1991, the authors performed 46 hallux interphalangeal joint arthroplasties on 40 patients (22 males, 18 females). Of the 40 original patients, one patient was lost to follow-up in the immediate postoperative period, leaving 45 procedures on 39 patients. Thirty-six feet were noted to heal both the procedure and ulceration uneventfully (80%). There were five minor complications (11%). Four cases were deemed failures (9%). Overall, 41 feet (91%) healed and had no evidence of recurrence in the follow-up period. Follow-up was an average of 23.6 months (range 4-44 months). The hallux interphalangeal joint arthroplasty has been a valuable procedure for chronic ulcerations of the hallux. By allowing these ulcers to heal, loss of the great toe has been avoided. Function and structure of the foot has been maintained.
- Published
- 1994
9. In-shoe foot pressure measurements in diabetic patients with at-risk feet and in healthy subjects.
- Author
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Sarnow MR, Veves A, Giurini JM, Rosenblum BI, Chrzan JS, and Habershaw GM
- Subjects
- Adult, Aged, Aged, 80 and over, Diabetes Mellitus, Type 1 complications, Diabetes Mellitus, Type 2 complications, Diabetic Foot etiology, Diabetic Foot physiopathology, Female, Humans, Male, Middle Aged, Risk Factors, Diabetes Mellitus, Type 1 physiopathology, Diabetes Mellitus, Type 2 physiopathology, Diabetic Foot epidemiology, Foot physiology, Walking physiology
- Abstract
Objective: To measure in-shoe foot pressures in diabetic patients and healthy subjects and compare them with the foot pressures when they walked without their shoes., Research Design and Methods: Forty-four diabetic patients at risk of foot ulceration and 65 healthy subjects were matched for age, sex, race, and weight. Neuropathy was evaluated clinically, and the F-Scan program was used to measure the foot pressures. Foot pressures were measured with the sensors placed in the shoes (S measurements), between the foot and the sock with shoes (H measurements) or with their socks alone (B measurements)., Results: In the control group, significant differences were found between S (4.77 +/- 1.87 kg/cm2) and H measurements (5.12 +/- 1.87 kg/cm2, P < 0.001), between S and B (7.23 +/- 2.95 kg/cm2, P < 0.0001), and between H and B (P < 0.0001). In the diabetic group, no difference was found between S and H measurements (5.28 +/- 2.22 vs. 5.27 +/- 2.39 kg/cm2, NS). In contrast, the B pressure was significantly higher when compared with both (8.77 +/- 4.67 kg/cm2, P < 0.02). When compared with the control group, the S and H pressures did not differ significantly, but the B pressure in the diabetic group was significantly higher (P < 0.02). The peak S pressure was above the normal limit in 24 (27%) diabetic and 21 (16%) control feet (P < 0.05), the H pressure in 17 (19%) diabetic feet and 22 (17%) control feet (NS), and the B pressure in 24 (27%) diabetic and 21 (16%) control feet (P < 0.05)., Conclusions: In-shoe foot pressure measurements are significantly lower than the ones measured when walking with the socks only in both diabetic patients and healthy subjects. The shoes of diabetic patients provided a higher pressure reduction than did those of the control group, but the number of feet with abnormally high pressures did not change. The F-Scan system may be particularly helpful in designing footwear suitable for diabetic patients with at-risk feet.
- Published
- 1994
- Full Text
- View/download PDF
10. Maximizing foot salvage by a combined approach to foot ischemia and neuropathic ulceration in patients with diabetes. A 5-year experience.
- Author
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Rosenblum BI, Pomposelli FB Jr, Giurini JM, Gibbons GW, Freeman DV, Chrzan JS, Campbell DR, Habershaw GM, and LoGerfo FW
- Subjects
- Aged, Arteries surgery, Diabetic Foot epidemiology, Diabetic Foot etiology, Diabetic Nephropathies epidemiology, Diabetic Nephropathies etiology, Female, Follow-Up Studies, Foot surgery, Humans, Ischemia epidemiology, Ischemia etiology, Male, Middle Aged, Time Factors, Amputation, Surgical, Diabetes Mellitus, Type 1 complications, Diabetes Mellitus, Type 2 complications, Diabetic Foot surgery, Diabetic Nephropathies surgery, Foot blood supply, Ischemia surgery, Salvage Therapy
- Abstract
Objective: The combination of peripheral neuropathy and arterial insufficiency in patients with diabetes frequently results in chronic non-healing foot ulcers. These patients often have a protracted course that commonly ends in limb amputation., Research Design and Methods: Since 1987, 39 diabetic patients presented with 42 neuropathic ulcerations beneath the lesser metatarsal heads, complicated by severe arterial insufficiency. A variety of vascular reconstructions were performed to improve circulation to the foot. After successful vascular reconstruction, 14 patients with deep ulcers underwent resection of the involved bone or joint through a plantar elliptical incision with excision of the ulcer and primary closure (33%). Five patients required a simultaneous panmetatarsal head resection (12%). For fifteen superficial ulcers, metatarsal osteotomy through a dorsal approach was performed (36%). Eight patients underwent a fifth metatarsal head resection through a dorsal approach (19%)., Results: In follow-up of 2-64 months (mean 21.2 months), 35 extremities with patent bypass grafts achieved and maintained primary healing of their local foot procedure (83%). Two feet required subsequent revision but ultimately healed (5%). Three feet (7%) developed a new plantar ulceration adjacent to the original one. In two extremities, the foot remained healed in spite of thrombosis of their grafts (5%). One patient with a thrombosed graft required a below-knee amputation. One patient died before the foot healed with a patent bypass graft. Overall, 40 of 42 extremities (95%) ultimately healed over the course of the follow-up period., Conclusions: We conclude that complex neuropathic ulcers in diabetic patients can be successfully treated by an aggressive surgical approach that removes infected bone and ulcers and corrects underlying structural abnormalities provided arterial insufficiency is corrected first.
- Published
- 1994
- Full Text
- View/download PDF
11. Tendo Achillis procedures for chronic ulcerations in diabetic patients with transmetatarsal amputations.
- Author
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Barry DC, Sabacinski KA, Habershaw GM, Giurini JM, and Chrzan JS
- Subjects
- Adult, Aged, Chronic Disease, Female, Foot Ulcer etiology, Humans, Male, Methods, Middle Aged, Achilles Tendon surgery, Amputation, Surgical adverse effects, Diabetes Complications, Foot Ulcer surgery, Metatarsus surgery
- Abstract
Recurrent ulceration following transmetatarsal amputation commonly results from hypertrophic bone formation or equinus deformity. In the current study, 31 diabetic patients underwent 33 Achilles tendon procedures for recurrent ulcerations at the distal stump of their transmetatarsal amputation. Primary healing was achieved in 21 procedures (64%) and secondary healing in 9 procedures (27%) for an overall healing rate of 91%. Two procedures failed to resolve the original ulceration (6%). The average follow-up examination was 27 months. The authors conclude that Achilles tendon procedures are an effective means of managing ulcerations in transmetatarsal amputation feet exhibiting an equinus deformity.
- Published
- 1993
- Full Text
- View/download PDF
12. Panmetatarsal head resection. A viable alternative to the transmetatarsal amputation.
- Author
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Giurini JM, Basile P, Chrzan JS, Habershaw GM, and Rosenblum BI
- Subjects
- Adult, Aged, Aged, 80 and over, Amputation, Surgical, Female, Foot Diseases surgery, Humans, Male, Metatarsus surgery, Middle Aged, Retrospective Studies, Diabetes Complications, Metatarsal Bones surgery
- Abstract
While the transmetatarsal amputation has resulted in the salvage of numerous diabetic limbs, it remains an ablative procedure with both short- and long-term complications. The authors reviewed their experience with the panmetatarsal head resection as an alternative to the transmetatarsal amputation. A retrospective review was performed of all patients having undergone this procedure between May 1986 and November 1991. Thirty-seven procedures were performed; of these, 34 were evaluated. The average follow-up period was 20.9 months. Thirty-two feet showed primary healing while one showed delayed healing. One patient had local recurrence of the original ulceration. Primary healing was 94% while overall success was 97%. No patient required amputation of any kind. The authors conclude that the panmetatarsal head resection is a viable alternative to the transmetatarsal amputation in properly selected patients because it avoids many of the structural and biomechanical pitfalls of the transmetatarsal amputation.
- Published
- 1993
- Full Text
- View/download PDF
13. Sesamoidectomy for the treatment of chronic neuropathic ulcerations.
- Author
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Giurini JM, Chrzan JS, Gibbons GW, and Habershaw GM
- Subjects
- Adult, Aged, Chronic Disease, Clinical Protocols, Decision Trees, Female, Foot Diseases etiology, Humans, Male, Metatarsophalangeal Joint, Middle Aged, Postoperative Care, Retrospective Studies, Skin Ulcer etiology, Diabetic Neuropathies complications, Foot Diseases surgery, Sesamoid Bones surgery, Skin Ulcer surgery
- Abstract
Neuropathic ulcerations in diabetic patients are frequent causes of hospitalizations and morbidity. The plantar aspect of the first metatarsophalangeal joint is a common location for these ulcerations, because of the significant weightbearing forces generated through this joint and the presence of sensory and motor neuropathy. The authors describe 24 cases in which excision of the tibial sesamoid, fibular sesamoid, or both, was performed to resolve these lesions.
- Published
- 1991
- Full Text
- View/download PDF
14. Charcot's disease in diabetic patients. Correct diagnosis can prevent progressive deformity.
- Author
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Giurini JM, Chrzan JS, Gibbons GW, and Habershaw GM
- Subjects
- Animals, Arthropathy, Neurogenic etiology, Arthropathy, Neurogenic therapy, Humans, Arthropathy, Neurogenic diagnosis, Diabetes Complications
- Abstract
Although Charcot's disease and its association with diabetes have been described many times in the literature, it is still often misdiagnosed and incorrectly treated as osteomyelitis, arthritis, or gout. The best safeguard is a high index of suspicion. A warm, swollen foot in a diabetic patient with long-standing neuropathy without local or systemic signs of infection must be considered Charcot's disease until proven otherwise. The principal treatment is total abstinence from putting weight on the foot until warmth, swelling, and redness subside. Protective weight-bearing methods may then be slowly instituted.
- Published
- 1991
- Full Text
- View/download PDF
15. Review of metatarsal osteotomies for the treatment of neuropathic ulcerations.
- Author
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Tillo TH, Giurini JM, Habershaw GM, Chrzan JS, and Rowbotham JL
- Subjects
- Adult, Aged, Female, Follow-Up Studies, Foot Diseases etiology, Humans, Male, Middle Aged, Osteotomy rehabilitation, Retrospective Studies, Skin Ulcer etiology, Diabetic Neuropathies complications, Foot Diseases surgery, Metatarsus surgery, Osteotomy standards, Skin Ulcer surgery
- Abstract
The records of 52 patients who underwent metatarsal osteotomies for the treatment of chronic neuropathic ulcerations between the years 1983 and 1985 were analyzed in a retrospective study. Long-term follow-up information was available for all but three patients. All patients were conservatively managed preoperatively and postoperatively with shoes, accommodative orthoses, and local care. A limb salvage rate of 94%, 46 of 49 patients, was achieved in this study. Although 13 patients developed transfer ulcerations, all but one were managed either with conservative care or a lesser podiatric procedure, and all remain healed to date.
- Published
- 1990
- Full Text
- View/download PDF
16. Panmetatarsal head resection in chronic neuropathic ulceration.
- Author
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Giurini JM, Habershaw GM, and Chrzan JS
- Subjects
- Adult, Aged, Chronic Disease, Diabetic Neuropathies complications, Female, Humans, Male, Middle Aged, Postoperative Care, Recurrence, Skin Ulcer etiology, Diabetic Neuropathies surgery, Metatarsus surgery, Skin Ulcer surgery
- Abstract
Jacobs (1) reported use of the Clayton modification of the Hoffman procedure on 12 patients as the procedure of choice in select diabetics with abscess and ulceration. He described a dorsal transverse incision, amputation of all metatarsal heads, through-and-through drainage from a dorsal to plantar direction at the site of abscess formation, and use of a Jackson-Pratt drain dorso-laterally. The authors describe a modification of this procedure that has been performed for 6 years.
- Published
- 1987
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