1.
Efficacy of preparation solutions and cleansing techniques on contamination of the skin in foot and ankle surgery: A systematic review and meta-analysis.
Yammine, K, Harvey, A
The bone & joint journal. 2013;(4):498-503
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Abstract
We report a systematic review and meta-analysis of published randomised and quasi-randomised trials evaluating the efficacy of pre-operative skin antisepsis and cleansing techniques in reducing foot and ankle skin flora. The post-preparation culture number (Post-PCN) was the primary outcome. The data were evaluated using a modified version of the Cochrane Collaboration’s tool. We identified eight trials (560 participants, 716 feet) that met the inclusion criteria. There was a significant difference in the proportions of Post-PCN between hallux nailfold (HNF) and toe web spaces (TWS) sites: 0.47 vs 0.22, respectively (95% confidence interval (CI) 0.182937 to 0.304097; p < 0.0001). Meta-analyses showed that alcoholic chlorhexidine had better efficacy than alcoholic povidone-iodine (PI) at HNF sites (risk difference 0.19 (95% CI 0.08 to 0.30); p = 0.0005); a two-step intervention using PI scrub and paint (S&P) followed by alcohol showed significantly better efficacy over PI (S&P) alone at TWS sites (risk difference 0.13 (95% CI 0.02 to 0.24); p = 0.0169); and a two-step intervention using chlorhexidine scrub followed by alcohol showed significantly better efficacy over PI (S&P) alone at the combined (HNF with TWS) sites (risk difference 0.27 (95% CI 0.13 to 0.40); p < 0.0001). No significant difference was found between cleansing techniques.
2.
Recombinant human PDGF-BB in foot and ankle fusion.
DiGiovanni, CW, Lin, S, Pinzur, M
Expert review of medical devices. 2012;(2):111-22
Abstract
Autogenous bone graft (autograft) is currently the gold standard for augmenting bone repair and fusion procedures of the foot and ankle. The time, cost and morbidity involved in obtaining autograft, however, are well documented and legitimate concerns remain surrounding this intervention. Endogenous human PDGF is chemotactic and mitogenic for osteoblasts and undifferentiated osteoprogenitor cells, and upregulates expression of cytokines necessary for osseous and soft tissue healing and regeneration. The BB isoform of PDGF, and the biosynthetic replica recombinant human PDGF-BB, is a key regulatory molecule in bone homeostasis, repair and regeneration. When combined with a β-tricalcium phosphate osteoconductive matrix, recombinant human PDGF-BB mitigates a number of problems associated with the use of autograft and, based on its preclinical performance and early clinical success, appears to be an equally effective and perhaps an even safer alternative to autograft for foot and ankle fusion (arthrodesis) procedures.
3.
Stem cells in bone grafting: Trinity allograft with stem cells and collagen/beta-tricalcium phosphate with concentrated bone marrow aspirate.
Guyton, GP, Miller, SD
Foot and ankle clinics. 2010;(4):611-9
Abstract
The orthopedic foot and ankle surgeon needs bone grafts in the clinical situation of fracture healing and in bone-fusion procedures. This article briefly outlines thought processes and techniques for 2 recent options for the surgeon. The Trinity product is a unique combination of allograft bone and allograft stem cells. The beta-tricalcium phosphate and collagen materials provide an excellent scaffold for bone growth; when combined with concentrated bone marrow aspirate, they also offer osteoconductive and osteoinductive as well as osteogenerative sources for new bone formation.
4.
High-risk foot and ankle patients.
Padanilam, TG, Donley, BG
Foot and ankle clinics. 2003;(1):149-57
Abstract
The surgical treatment of complicated foot and ankle problems requires recognition and appreciation of patient and disease characteristics that may compromise surgical results. Appropriate patient selection is an important factor in obtaining a successful outcome. Modulation and management of these patient characteristics are critical in minimizing complications that are associated with treatment.
5.
Current trends in preoperative patient evaluation and management for podiatric surgeons.
Skully, R, Beasley, CA, Lutz, KW
Clinics in podiatric medicine and surgery. 2003;(2):213-35, vii
Abstract
In preparation for elective foot and ankle surgery, the podiatric surgeon often will refer the patient for a preoperative evaluation. Surgeons rely on the input of that consultant to provide a determination as to the operative risk for the patient. This article reviews the fundamental parts of the preoperative evaluation, perioperative patient management, and recent changes and trends within this arena.
6.
Perioperative pain control.
Davy, TA, Sharp, C, Lynch, S
Clinics in podiatric medicine and surgery. 2003;(2):257-67
Abstract
There are many options for perioperative pain control available to surgeons. Given these options, adequate levels of analgesia should be achieved and maintained in all surgical patients. Data suggest that analgesia may be improved by combining different analgesic approaches. To avoid high-dose requirements, dose-dependent adverse effects, and potential toxicity associated with reliance on one agent or technique, "balanced" or multimodal analgesic regimens have been advocated. A multimodal recovery program consists of three major components: (1) early mobilization, (2) complete perioperative analgesia, and (3) early oral nutrition. The goal of multimodal programs is to accelerate patient rehabilitation and reduce hospital stays. Balanced multimodal programs are the present and future of perioperative pain control and will enhance patient care.