(iii) Surgery of the rheumatoid forefoot

Rheumatoid forefoot deformity: pathophysiology, evaluation and operative treatment options

“…In techniques preserving the MT heads decompression in order to relocate the soft tissues is accomplished through tendon releases, resection of bone of the proximal phalanges, through shortening arthrodesis of the proximal interphalangeal (PIP) joints or by shortening the MT bones [35,46,[51][52][53][54][55][56][57][58][59][60][61][62][63][64] (Fig. 7).…”

Piecrusting to Facilitate Skin Closure

“…The piecrusting technique, using small transdermal incisions made in the surrounding skin similar to the holes in a pie crust, is not new and has also been termed multiple superficial short skin incisions (nicks), lace patterning, fishmouthing, meshing technique, multiple relaxing skin incisions, and tissue meshing advancement flap. [1][2][3][4][5][6][7][8][9][10] Table 1 lists the references in the English literature on the technique that, however, does not seem to be widely known. 11 The piecrusting technique is particularly useful in the dorsum of the foot after a forefoot reconstruction performed in both rheumatoid and nonrheumatoid patients, with a recent trend toward metatarsal head preservation.…”

“…She wrote up her technique in 2002. 8 Hak and Lee in 2006 described tension-free closure of a wound breakdown over the distal fibula with an exposed screw head, after treatment of infection and excision of the affected area, with small pie-crust stab wounds. 9 Dunbar et al in 2007 described using multiple parallel incisions in a pie crust fashion to facilitate decompression of severely injured midfoot and forefoot injuries with a closed soft tissue envelope.…”

“…All authors have described the piecrusting meshing technique as being easy, avoiding donor graft morbidity, quicker to heal than healing by secondary intention, and wound care being minimal with few complications. [1][2][3][4][5][6][7][8][9][10][11] The cosmetic results were satisfactory for most body sites. It can be seen from Table 1 that, apart from Hasenhuttl, all the incisions used have been transdermal; the expansion of the small incisions into oval shapes is indeed more effective in transdermal rather than superficial incisions.…”