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Charles M Zelen, DPM FACFAS FACFAOMClinical Assistant Professor Department of Medicine; University of Virginia
Podiatry Section Chief; Department of Orthopedics, Lewis Gale HospitalPodiatry Section Chief; Department of Surgery, Roanoke Memorial
President; Virginia Podiatric Medical Association
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Literature ReviewLiterature ReviewRisks of Charcot SurgeryRisks of Charcot Surgery
2 of 5 ankle fusions successful (40%)2 of 5 ankle fusions successful (40%)2 of 5 ankle fusions successful (40%). 2 of 5 ankle fusions successful (40%). –– Samilson, R., Sankaras, B., Bersani, F., & Smith, A. Samilson, R., Sankaras, B., Bersani, F., & Smith, A.
Orthopedic management of neuropathic joints. Arch. Orthopedic management of neuropathic joints. Arch. Surg., 78:115, 1959.Surg., 78:115, 1959.
38% of patients with neuropathic arthropathy 38% of patients with neuropathic arthropathy received a satisfactory ankle fusion. received a satisfactory ankle fusion. yy–– Stuart, M., and Morey, B. Clin. Ortho., 253:209Stuart, M., and Morey, B. Clin. Ortho., 253:209--211, 211,
1990.1990.
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Literature ReviewLiterature ReviewRisks of Charcot SurgeryRisks of Charcot Surgery
Ni d th i 29 ti t fNi d th i 29 ti t fNine pseudoarthroses in 29 patients for Nine pseudoarthroses in 29 patients for arthrodesis of Charcot (31% Non Union Rate)arthrodesis of Charcot (31% Non Union Rate)–– Papa, J., Myerson, M., & Girard, Pierre. Salvage, with Papa, J., Myerson, M., & Girard, Pierre. Salvage, with
Arthrodesis, in Intractable Diabetic Neuropathic Arthrodesis, in Intractable Diabetic Neuropathic Arthropathy of the Foot and Ankle. J. Bone and Joint Arthropathy of the Foot and Ankle. J. Bone and Joint Surgery. Vol 75Surgery. Vol 75--A, No.7, July 1993.A, No.7, July 1993.
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Charcot’s ArthropathyCharcot’s Arthropathy
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ComplicationsComplicationsofof
Diabetic/NeuropathicDiabetic/NeuropathicReconstructionsReconstructions
NonNon--Union / MalunionUnion / Malunion–– AVNAVN–– Failure of Internal Failure of Internal –– External FixationExternal Fixation
InfectionInfection–– Soft TissueSoft TissueSo t ssueSo t ssue–– OsteomyelitisOsteomyelitis
Wound ComplicationsWound Complications
ComplicationsComplicationsofof
Diabetic/NeuropathicDiabetic/NeuropathicReconstructionsReconstructions
Wound Complications Wound Complications –– TreatmentTreatment–– Use of the reconstructive Step LadderUse of the reconstructive Step Ladder
1) Local Wound Care1) Local Wound Care2) Negative Pressure Wound Management2) Negative Pressure Wound Management3) Skin Grafting3) Skin Grafting4) Local / Random Flaps4) Local / Random Flaps4) Local / Random Flaps4) Local / Random Flaps5) Intrinsic Muscle Pedicle Flaps5) Intrinsic Muscle Pedicle Flaps
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ComplicationsComplicationsofof
Diabetic/NeuropathicDiabetic/NeuropathicReconstructionsReconstructions
Wound Complications Wound Complications –– TreatmentTreatment–– Use of the reconstructive Step LadderUse of the reconstructive Step Ladder
1) Local Wound Care1) Local Wound Care
ComplicationsComplicationsofof
Diabetic/NeuropathicDiabetic/NeuropathicReconstructionsReconstructions
Wound Complications Wound Complications –– TreatmentTreatment–– Use of the reconstructive Step LadderUse of the reconstructive Step Ladder
2) Negative Pressure Wound Management2) Negative Pressure Wound Management
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ComplicationsComplicationsofof
Diabetic/NeuropathicDiabetic/NeuropathicReconstructionsReconstructions
Wound Complications Wound Complications –– TreatmentTreatment–– Use of the reconstructive Step LadderUse of the reconstructive Step Ladder
3) Skin Grafting3) Skin Grafting
ComplicationsComplicationsofof
Diabetic/NeuropathicDiabetic/NeuropathicReconstructionsReconstructions
Wound Complications Wound Complications –– TreatmentTreatment–– Use of the reconstructive Step LadderUse of the reconstructive Step Ladder
4) Local / Random Flaps4) Local / Random Flaps
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ComplicationsComplicationsofof
Diabetic/NeuropathicDiabetic/NeuropathicReconstructionsReconstructions
Wound Complications Wound Complications –– TreatmentTreatment–– Use of the reconstructive Step LadderUse of the reconstructive Step Ladder
5) Intrinsic Muscle Pedicle Flaps5) Intrinsic Muscle Pedicle Flaps
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FailureFailureOfOfOfOf
Charcot Charcot PlantarPlantarPlantar Plantar PlaningPlaning
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CharcotCharcotFailureFailureFailureFailure
Of Internal Of Internal FixationFixationFixationFixation
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CMT CMT -- NeuropathyNeuropathyF ilF ilFailureFailure
Of Ankle ImplantOf Ankle Implant
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ConclusionsConclusions
ConclusionsConclusions
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