Laterale Supramalleolarlappenplastiken zur Defektdeckung im Sprunggelenks- und Fußbereich

Objective

Defect reconstruction by transposition of well-vascularized thin and pliable skin.

Indications

Defect coverage involving the antero- and dorsolateral distal one third of the lower leg, the dorsolateral and dorsomedial hindfoot and dorsal midfoot.

Contraindications

Severe peripheral arterial occlusive disease (PAOD), previous trauma at the anterolateral aspect of the lower leg and foot.

Surgical technique

Lateral fasciocutaneous supramalleolar flap with orthograde blood flow, fasciocutaneous lateral supramalleolar perforator flap with orthograde blood flow, adipofascial lateral supramalleolar flap with orthograde blood flow, lateral fasciocutaneous supramalleolar flap based on the lateral tarsal artery with retrograde blood flow, lateral fasciocutaneous supramalleolar flap based on the anterolateral malleolar artery with retrograde blood flow according to Oberlin.

Postoperative management

“Tie over” dressing for grafting site for 5 days (healing of split/full-thickness skin graft), complete immobilization of the lower leg for 7 days in a dorsal plaster splint (ensure that there is no pressure on the flap), progressive increase of range of motion after 1 week, postoperative standardized compression therapy, combined with scar therapy (silicone sheet).

Results

Reliable, excellent functional and aesthetic results with thin skin in small to midsize defects. Increasing morbidity of grafting site in larger flaps and risk of neuroma when the superficial peroneal nerve was exposed.     

Luxationen im Bereich des Mittelfußes

Ohne Zusammenfassung (Mit 13 Abbildungen.)     

Aufbautypen und Blutversorgung des Fußes im Zusammenhang mit dem Mechanismus des Plattfußes

Ohne Zusammenfassung Mit 8 Textabbildungen.     

Frakturen des kindlichen Sprunggelenks und Fußes

Ankle fractures are the most frequent factures of weight-bearing joints in children while fractures of the hindfoot and midfoot are rare. Metatarsal fractures make up the greatest portion of foot fractures in children and mostly heal uneventfully. Generally, the fracture severity increases with increasing age and the fracture patterns in adolescents resemble those in adults but transitional fractures of the distal tibial epiphysis in adolescents between 12 and 14 years of age are an exception. A subtle clinical and radiographic examination is necessary to detect the injury pattern and to discriminate fractures from accessory bones, juvenile avascular necrosis and apophyses. Computed tomography scanning is most useful to precisely evaluate the degree of injury, especially articular involvement and to allow precise planning of the operative approach. Except for the calcaneus and the metatarsals the bones of the foot and ankle do not display a significant potential for spontaneous correction during growth; therefore, open reduction and internal fixation is indicated in all displaced fractures if closed reduction does not yield a satisfying result in order to avoid relevant post-traumatic deformities.     

Einsatz des SPECT-CT in der Fuß- und Sprunggelenkchirurgie

The SPECT-CT is a hybrid imaging of a scintigraphy and a CT. It allows to correlate activity with structural changes from the CT and identify pathologies with a high spatial resolution. The pathologies correlate highly with clinical symptoms. Especially in patients with complex diseases of the foot and ankle additional information can be gained.     

Der benigne tenosynoviale Riesenzelltumor im Bereich des oberen Sprunggelenks Seltene Differentialdiagnose eines Weichteiltumors am Fuß

The giant cell synovioma is a benign neoplasia classically located in the fingers. It mostly rises from tendon sheaths, sometimes from the synovia. Other locations than the fingers are rare. Making a differential diagnosis to lipomas, gangliomas or even malignant soft tissue tumors can be very difficult especially in rare locations. We report the case of a 21 years old man suffering from a giant cell synovioma in the area of the right ankle joint. The clinical, radiological and patho-morphological findings are documented. The tumor was excised totally, other foci were not found. The problems of making the right diagnosis are described.     

Osteochondrosen des kindlichen Fußes

Osteochondrosis is a heterogeneous group of self-limiting conditions characterized by disturbance of enchondral ossification caused by a lack of circulation. Foot pain is a relatively common problem in children and adolescents and may be due to osteochondrosis. Osteochondrosis of the growing foot shows painful radiological alterations including increased density, fragmentation and irregularity of the epiphyses, physes and apophyses. Lacking etiologic and pathophysiologic information, ostoechondroses have been documented in almost every bone of the foot and therefore should be considered in the differential diagnosis when evaluating pediatric foot pain. The most common localizations of osteochondroses of the growing foot include the navicular as Kohler’s syndrome, the metatarsal as Freiberg’s infraction and calcaneal apophysitis as Sever’s disease. Prognosis and final outcome vary considerably between the different localizations. Physicians should therefore be informed about the etiology, clinical presentation and treatment options for osteochondroses of the growing foot.     

Die Entstehung der inkonstanten Skeletelemente und ihre Beziehung zur Pathologie des Fußes

Ohne Zusammenfassung Mit 22 Textabbildungen (=33 Einzelbildern).     

Der deepithelialisierte “turn-over-flap” zur Defektdeckung im Bereich über der Achillessehne und über der lateralen Malleolarregion

The deepithelialized "turn-over-flap" is a reversed dermis flap. The pedicle of the flap remains intact. The mobile upper part of the flap is turned over the defect and the pedicle itself. A mesh graft covers both, the flap and the donor side. Two case reports will present the principles of the flap design and the clinical outcome of a patient with a defect over the lateral malleolar region and a patient with a defect over the Achilles tendon.     

Rekonstruktionsmaßnahmen nach veralteten Frakturen und Luxationen des Fußes

Inveterated fractures or dislocations of the foot which are defined as being more than 6–12 weeks old can be secondarily reconstructed anatomically in only very rare cases. All other cases need reorientation of all axes of the foot requiring single or combined joint fusion. In cases of significant posttraumatic bone necrosis the dead bone has to be radically resected and substituted by an autogenous bone graft from the iliac crest. Old cases of dislocation, for example after subtalar dislocation without anatomical reduction, need reorientation of the foot axes by performing arthrodesis. Subluxation of the medial Lisfranc joint after an unrecognized rupture of Lisfranc ligament can be controlled later by anatomical repair of this ligament by using half of the extensor digitorum longus tendon and thus avoiding arthrodesis.     

Rekonstruktionsmaßnahmen nach veralteten Frakturen und Luxationen des Fußes

Inveterated fractures or dislocations of the foot which are defined as being more than 6–12 weeks old can be secondarily reconstructed anatomically in only very rare cases. All other cases need reorientation of all axes of the foot requiring single or combined joint fusion. In cases of significant posttraumatic bone necrosis the dead bone has to be radically resected and substituted by an autogenous bone graft from the iliac crest. Old cases of dislocation, for example after subtalar dislocation without anatomical reduction, need reorientation of the foot axes by performing arthrodesis. Subluxation of the medial Lisfranc joint after an unrecognized rupture of Lisfranc ligament can be controlled later by anatomical repair of this ligament by using half of the extensor digitorum longus tendon and thus avoiding arthrodesis.     

Die dorso-plantare Aufklappung zur Ankylosierung zahlreicher Gelenke des Fußes

Ohne Zusammenfassung (Mit 5 Abbildungen.)     

Die Einlagenversorgung des rheumatischen Fußes

BACKGROUND: Insoles are regarded as an appropriate tool for the management of rheumatic foot disorders. However, a quality control for this purpose has not been established. In our study, the clinical effectiveness of insoles used in patients with rheumatic foot disorders was addressed. In addition, we sought to establish pedobarography as a means of quality control for orthotic management of the rheumatic foot. MATERIAL AND METHODS: Our study included 20 rheumatoid arthritis patients with painful rheumatic foot deformities who were provided with insoles. Clinical data were obtained by physical examination and a 100-mm pain scale. Pedobarography was performed using the novel pedar cable system with new and individually designed insoles and after a 6-month follow-up. A shoe-only trial served as control. The parameters maximum force, peak pressure, force-time integral, and average pressure were analyzed in anatomical regions and an individually defined overloaded forefoot region. RESULTS: Clinical improvement was significant after a 6-month follow-up in spite of a heterogeneous group of patients. However, our results could not confirm consistent changes in plantar pressure distribution. CONCLUSION: As a conclusion, further efforts are necessary to establish a quality control for orthotic management of the rheumatic foot.