Browsing by Author "Armstrong, David G"

Now showing 1 - 2 of 2
  • Thumbnail Image
    ItemOpen Access
    Diabetic limb salvage procedure with bone allograft and free flap transfer: a case report.
    (Diabetic foot & ankle, 2017-01) Godoy-Santos, Alexandre L; Amodio, Daniel T; Pires, André; Lima, Ana LM; Wei, Teng H; de Cesar-Netto, Cesar; Armstrong, David G
    The aim of this case report was to describe a successful diabetic limb salvage procedure in the treatment of an infected diabetic foot ulcer through a multidisciplinary team approach and complex surgical reconstruction involving a femoral head bone allograft and musculocutaneous latissimus dorsi free flap. The decision to proceed with aggressive staged efforts at diabetic limb salvage should be made only after careful consultation with the patient, his or her family, and the rest of the multidisciplinary healthcare team.
  • Thumbnail Image
    ItemOpen Access
    Staged salvage of diabetic foot with Chopart amputation and intramedullary nailing.
    (SAGE open medical case reports, 2021-01) Godoy-Santos, Alexandre Leme; Fonseca, Fábio Correa; de Cesar-Netto, Cesar; Bang, Katrina; Pires, Eduardo Araujo; Armstrong, David G
    We present a stepwise surgical approach that can be used, in lieu of a transtibial amputation, to preserve the lower limb in the setting of severe diabetic foot infections. A 63-year-old male status post left midfoot (Lisfranc's) amputation presented to our hospital with a 4-year history of a left foot diabetic ulcer with associated purulent drainage and intermittent chills. On initial exam, the patient's left foot amputation stump was plantarflexed, grossly erythematous, and edematous. The associated diabetic foot ulcer was actively draining purulent fluid. Following workup with radiography and ultrasound, the patient was diagnosed with a post-operative infection of the midfoot at the level of the amputation stump secondary to diabetic neuropathy. Our approach to management was a staged and included (1) surgical irrigation and debridement of the distal stump wound, (2) provisional negative pressure therapy, (3) a second-look procedure, and (4) a tibiotalocalcaneal fusion was performed using a lateral transfibular and plantar approach, after wound closure and resolution of active infection was achieved. At 36-month follow-up, the patient was fully weight-bearing in stiff sole sneakers with no gross overt alteration of gait pattern. The patient scored 79 points when assessed by the hindfoot American Orthopaedic Foot and Ankle Society Ankle-Hindfoot outcome score. In the patient with diabetes and cardiological restrictions, a Chopart amputation is preferred due to the decreased level of energy expenditure required for ambulation as compared to over more proximal levels of amputation.