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Use of a definitive cement spacer for simultaneous bony and soft tissue reconstruction of mid- and hindfoot diabetic neuroarthropathy:a case report.
J Foot Ankle Surg. 2015 Jan-Feb; 54(1):120-5.JF

Abstract

The prevalence of diabetes mellitus has been increasing, and ≤25.8 million people, or 8.3% of the US population, have diabetes. Diabetic Charcot arthropathy and foot ulcers are serious complications of diabetes mellitus. They have been associated with greater risks of lower extremity amputation and mortality. Studies have shown that the amputation risk relative to patients with Charcot arthropathy alone is 7 times greater for patients with a foot ulcer, and 12 times greater for patients with Charcot arthropathy and a foot ulcer. Surgical reconstruction of Charcot arthropathy of the foot is often difficult, because of bone loss, deformities, vasculopathy, and the presence of active infection with or without soft tissue loss. It will be even more challenging if >1 region of the foot has been affected, such as the mid- and hindfoot. In such situations, an amputation would usually be the surgical option. We present a case of limb-threatening Charcot deformity with instability complicated by osteomyelitis, bone loss, and a large soft tissue defect. We used a limb salvage strategy with hindfoot fusion combined with an antibiotic-impregnated cement spacer for reconstruction of the midfoot, which was performed simultaneously with a local adipofascial flap for soft tissue coverage, resulting in a plantigrade, painless, and functional foot.

Authors+Show Affiliations

University Orthopaedic, Hand and Reconstructive Microsurgery Cluster, National University Hospital, Singapore, Singapore. Electronic address: choonchiet@gmail.com.University Orthopaedic, Hand and Reconstructive Microsurgery Cluster, National University Hospital, Singapore, Singapore.University Orthopaedic, Hand and Reconstructive Microsurgery Cluster, National University Hospital, Singapore, Singapore.University Orthopaedic, Hand and Reconstructive Microsurgery Cluster, National University Hospital, Singapore, Singapore.

Pub Type(s)

Case Reports
Journal Article

Language

eng

PubMed ID

25456343

Citation

Hong, Choon Chiet, et al. "Use of a Definitive Cement Spacer for Simultaneous Bony and Soft Tissue Reconstruction of Mid- and Hindfoot Diabetic Neuroarthropathy:a Case Report." The Journal of Foot and Ankle Surgery : Official Publication of the American College of Foot and Ankle Surgeons, vol. 54, no. 1, 2015, pp. 120-5.
Hong CC, Jin Tan K, Lahiri A, et al. Use of a definitive cement spacer for simultaneous bony and soft tissue reconstruction of mid- and hindfoot diabetic neuroarthropathy:a case report. J Foot Ankle Surg. 2015;54(1):120-5.
Hong, C. C., Jin Tan, K., Lahiri, A., & Nather, A. (2015). Use of a definitive cement spacer for simultaneous bony and soft tissue reconstruction of mid- and hindfoot diabetic neuroarthropathy:a case report. The Journal of Foot and Ankle Surgery : Official Publication of the American College of Foot and Ankle Surgeons, 54(1), 120-5. https://doi.org/10.1053/j.jfas.2014.10.009
Hong CC, et al. Use of a Definitive Cement Spacer for Simultaneous Bony and Soft Tissue Reconstruction of Mid- and Hindfoot Diabetic Neuroarthropathy:a Case Report. J Foot Ankle Surg. 2015 Jan-Feb;54(1):120-5. PubMed PMID: 25456343.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Use of a definitive cement spacer for simultaneous bony and soft tissue reconstruction of mid- and hindfoot diabetic neuroarthropathy:a case report. AU - Hong,Choon Chiet, AU - Jin Tan,Ken, AU - Lahiri,Amitabha, AU - Nather,Aziz, Y1 - 2014/11/15/ PY - 2012/12/12/received PY - 2014/12/3/entrez PY - 2014/12/3/pubmed PY - 2015/8/13/medline KW - Charcot arthropathy KW - cement spacer KW - diabetic foot wound KW - internal fixation KW - osteomyelitis SP - 120 EP - 5 JF - The Journal of foot and ankle surgery : official publication of the American College of Foot and Ankle Surgeons JO - J Foot Ankle Surg VL - 54 IS - 1 N2 - The prevalence of diabetes mellitus has been increasing, and ≤25.8 million people, or 8.3% of the US population, have diabetes. Diabetic Charcot arthropathy and foot ulcers are serious complications of diabetes mellitus. They have been associated with greater risks of lower extremity amputation and mortality. Studies have shown that the amputation risk relative to patients with Charcot arthropathy alone is 7 times greater for patients with a foot ulcer, and 12 times greater for patients with Charcot arthropathy and a foot ulcer. Surgical reconstruction of Charcot arthropathy of the foot is often difficult, because of bone loss, deformities, vasculopathy, and the presence of active infection with or without soft tissue loss. It will be even more challenging if >1 region of the foot has been affected, such as the mid- and hindfoot. In such situations, an amputation would usually be the surgical option. We present a case of limb-threatening Charcot deformity with instability complicated by osteomyelitis, bone loss, and a large soft tissue defect. We used a limb salvage strategy with hindfoot fusion combined with an antibiotic-impregnated cement spacer for reconstruction of the midfoot, which was performed simultaneously with a local adipofascial flap for soft tissue coverage, resulting in a plantigrade, painless, and functional foot. SN - 1542-2224 UR - https://www.unboundmedicine.com/medline/citation/25456343/Use_of_a_definitive_cement_spacer_for_simultaneous_bony_and_soft_tissue_reconstruction_of_mid__and_hindfoot_diabetic_neuroarthropathy:a_case_report_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S1067-2516(14)00535-3 DB - PRIME DP - Unbound Medicine ER -