Diabetic foot ulcerations are historically difficult to treat despite advanced
therapeutic modalities. There are numerous modalities described in the literature ranging
from noninvasive topical wound care to more invasive surgical procedures such as
primary closure, skin flaps, and skin grafting. While skin grafting provides faster time to
closure with a single treatment compared to traditional topical wound treatments, the
potential risks of donor site morbidity and poor wound healing unique to the diabetic
state have been cited as a contraindication to its widespread use. In order to garner
clarity on this issue, a literature review was undertaken on the use of split-thickness skin
grafts on diabetic foot ulcers. Search of electronic databases yielded four studies that
reported split-thickness skin grafts as definitive means of closure. In addition, several
other studies employed split-thickness skin grafts as an adjunct to a treatment that was
only partially successful or used to fill in the donor site of another plastic surgery
technique. When used as the primary closure on optimized diabetic foot ulcerations,
split-thickness skin grafts are 78% successful at closing 90% of the wound by eight weeks.
Cutaneous T-cell lymphoma is a type of non-Hodgkin's lymphoma, which is a neoplasm affecting the lymphatic system. Mycosis fungoides is the most common subset of cutaneous T-cell lymphoma and is often treated conservatively. This neoplasm is most common in adults older than 60 years and does not regularly manifest in the toes. A case is reported of a 70-year-old man seen for a nonhealing hallux ulceration leading to amputation. Histopathologic examination revealed a rare transformed CD30(+) high-grade cutaneous T-cell lymphoma. The morbidity of lymphomas is highly dependent on type and grade. Pharmaceutical precision therapies exist that target specific molecular defects or abnormally expressed genes, such as high expression of CD30. This article focuses on treatment protocol and emphasizes the importance of early diagnosis, determination of cell type, and proper referral of atypical dermatologic lesions.
Plantar plate repairs are challenging procedures because of the small anatomy of the plantar plate. This can make them daunting, time-consuming procedures to perform. Advances in technology, such as interference screws and small suture passers, have created improved technique possibilities to decrease difficulty, correct multiple planes of deformity, create stronger constructs, and improve patient results. The plantar plate repair technique presented in this article includes a dorsal approach with a metatarsal osteotomy, a knotless repair that provides a strong construct to allow patients to protectively bear weight immediately, and can reduce operative time by presenting tips to quickly navigate the procedure. The presented technique allows for detailed correction of all three planes of deformity, maximizing patient results.
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