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- Department of Surgery (27)
- Humans (19)
- Diabetic Foot (11)
- External Fixators (10)
- Surgical Flaps (8)
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- Arthropathy (7)
- Neurogenic (7)
- Treatment Outcome (6)
- Wound Healing (6)
- Arthrodesis (5)
- Debridement (5)
- Limb Salvage (4)
- Male (4)
- Subtalar Joint (4)
- Ankle Joint (3)
- Bone (3)
- Calcaneus (3)
- Combined Modality Therapy (3)
- Forefoot (3)
- Fracture Fixation (3)
- Fractures (3)
- Human (3)
- Osteomyelitis (3)
- Postoperative Complications (3)
- Reconstructive Surgical Procedures (3)
- Reoperation (3)
- Adult (2)
- Amputation (2)
- Chronic Disease (2)
- Diabetes Complications (2)
Articles 1 - 28 of 28
Full-Text Articles in Medicine and Health Sciences
Use Of Circular External Fixation For Combined Subtalar Joint Fusion And Ankle Distraction., Thomas Zgonis, John Stapleton, Thomas S Roukis
Use Of Circular External Fixation For Combined Subtalar Joint Fusion And Ankle Distraction., Thomas Zgonis, John Stapleton, Thomas S Roukis
John J Stapleton DPM, FACFAS
The authors discuss a novel technique not previously published that incorporates a subtalar joint arthrodesis with an ankle joint arthrodiastasis as an alternative to a tibiotalocalcaneal arthrodesis. Young and active patients who experience refractory pain and stiffness to the rearfoot and ankle secondary to combined severe subtalar and ankle arthrosis are suitable candidates for this surgical procedure. This new approach is based on sound principles in the treatment of severe arthrosis affecting the ankle and subtalar joint. The authors are currently prospectively reviewing their surgical experience with this procedure and believe that it provides an alternative option for the patient, …
Surgical Management Of Diabetic Foot And Ankle Infections., Claire M Capobianco, John Stapleton, Thomas Zgonis
Surgical Management Of Diabetic Foot And Ankle Infections., Claire M Capobianco, John Stapleton, Thomas Zgonis
John J Stapleton DPM, FACFAS
Delayed treatment of any diabetic foot infection can lead to a limb- or life-threatening scenario. Urgent and/or emergent surgery may be necessary in the early diagnosis of a severe diabetic foot infection that is followed by staged reconstructive procedures. This article provides the reader with a thorough understanding of the surgical management of severe diabetic foot infections and describes and guides treatment based on a rational schematic approach that identifies the anatomic location of the diabetic foot infection.
Innovative Techniques In Preventing And Salvaging Neurovascular Pedicle Flaps In Reconstructive Foot And Ankle Surgery., Thomas Zgonis, John Stapleton
Innovative Techniques In Preventing And Salvaging Neurovascular Pedicle Flaps In Reconstructive Foot And Ankle Surgery., Thomas Zgonis, John Stapleton
John J Stapleton DPM, FACFAS
Pedicle flaps to cover soft tissue defects of the foot, ankle, and lower extremity are invaluable. However, venous congestion and flap necrosis, a common complication, poses greater morbidity to the patient as few remaining options for attempted limb salvage remain. The authors discuss how to prevent flap failure by allowing close observation and strict offloading of the pedicle flap through current external fixation designs. This article also discusses the role of medicinal leeches in reestablishing blood flow through the pedicle flap to prevent tissue necrosis. In addition, the use of hydrosurgery as an innovative technique offers the surgeon another option …
Negative-Pressure Wound Therapy In The Management Of Diabetic Charcot Foot And Ankle Wounds., Crystal L Ramanujam, John Stapleton, Thomas Zgonis
Negative-Pressure Wound Therapy In The Management Of Diabetic Charcot Foot And Ankle Wounds., Crystal L Ramanujam, John Stapleton, Thomas Zgonis
John J Stapleton DPM, FACFAS
As the prevalence of diabetes mellitus continues to rise, innovative medical and surgical treatment options have increased dramatically to address diabetic-related foot and ankle complications. Among the most challenging clinical case scenarios is Charcot neuroarthropathy associated with soft tissue loss and/or osteomyelitis. In this review article, the authors present a review of the most common utilizations of negative-pressure wound therapy as an adjunctive therapy or combined with plastic surgery as it relates to the surgical management of diabetic Charcot foot and ankle wounds.
Internal And External Fixation Approaches To The Surgical Management Of Calcaneal Fractures., John Stapleton, Gennady Kolodenker, Thomas Zgonis
Internal And External Fixation Approaches To The Surgical Management Of Calcaneal Fractures., John Stapleton, Gennady Kolodenker, Thomas Zgonis
John J Stapleton DPM, FACFAS
Calcaneal fractures are one of the most difficult fractures to surgically manage and often require a steep learning curve to achieve consistent results. They usually occur in young individuals with labor intensive occupations and are associated with major complications. Conservative treatment of intraarticular calcaneal fractures with displacement often results in significant deformity, bone loss, and posttraumatic arthrosis. Optimally, an open approach is required in most cases to achieve anatomic reduction and successful long-term outcomes.
Corrective Midfoot Osteotomies., John Stapleton, Lawrence Didomenico, Thomas Zgonis
Corrective Midfoot Osteotomies., John Stapleton, Lawrence Didomenico, Thomas Zgonis
John J Stapleton DPM, FACFAS
No abstract provided.
Soft Tissue Reconstruction Pyramid In The Diabetic Foot., Claire M Capobianco, John Stapleton, Thomas Zgonis
Soft Tissue Reconstruction Pyramid In The Diabetic Foot., Claire M Capobianco, John Stapleton, Thomas Zgonis
John J Stapleton DPM, FACFAS
Foot complications and ulceration are well-known sequelae to uncontrolled diabetes. Patients with chronic foot ulcers or wounds resulting from surgical debridement of deep-space infections are at continued risk for development of osteomyelitis and potential amputation. Moreover, these wounds often necessitate multiple outpatient clinic visits, daily dressing care, and prolonged periods of non-weight bearing, all of which have been shown to adversely affect the patient's quality of life. After a prudent period of wound-healing response, the authors believe that early and aggressive soft tissue reconstruction is in the patient's best interest and is crucial for resolution of the chronic nonhealing wound. …
Advanced Plastic Surgery Techniques For Soft Tissue Coverage Of The Diabetic Foot., Thomas Zgonis, John Stapleton, Thomas S Roukis
Advanced Plastic Surgery Techniques For Soft Tissue Coverage Of The Diabetic Foot., Thomas Zgonis, John Stapleton, Thomas S Roukis
John J Stapleton DPM, FACFAS
Obtaining stable, durable, and functional wound closure of a diabetic foot wound or open pedal amputation through plastic surgical techniques is essential to limit the potential for repeated ulceration, infection, and "supra-pedal" amputation. Myriad conservative and surgical techniques can be used to obtain wound closure. The authors discuss their approach and present operative pearls for their most commonly employed plastic surgical techniques to provide adequate soft tissue coverage of diabetic foot wounds. Emphasis is placed on the techniques necessary to perform these procedures and the surgical thought process involved in closing diabetic foot wounds.
Diabetic Foot Infections: A Team-Oriented Review Of Medical And Surgical Management., Claire M Capobianco, John Stapleton
Diabetic Foot Infections: A Team-Oriented Review Of Medical And Surgical Management., Claire M Capobianco, John Stapleton
John J Stapleton DPM, FACFAS
As the domestic and international incidence of diabetes and metabolic syndrome continues to rise, health care providers need to continue improving management of the long-term complications of the disease. Emergency department visits and hospital admissions for diabetic foot infections are increasingly commonplace, and a like-minded multidisciplinary team approach is needed to optimize patient care. Early recognition of severe infections, medical stabilization, appropriate antibiotic selection, early surgical intervention, and strategic plans for delayed reconstruction are crucial components of managing diabetic foot infections. The authors review initial medical and surgical management and staged surgical reconstruction of diabetic foot infections in the inpatient …
Diabetic Lisfranc Fracture-Dislocations And Charcot Neuroarthropathy., Bradley A Levitt, John Stapleton, Thomas Zgonis
Diabetic Lisfranc Fracture-Dislocations And Charcot Neuroarthropathy., Bradley A Levitt, John Stapleton, Thomas Zgonis
John J Stapleton DPM, FACFAS
The goal with Lisfranc fracture-dislocations is to regain joint congruity and reestablish midfoot stability to avoid debilitating posttraumatic arthrosis and chronic pain in the sensate patient. In the diabetic population, dense peripheral neuropathy and/or vascular disease are equally important and may alter the surgical approach to traumatic tarsometatarsal injuries. The initial diagnosis in the diabetic population may be delayed due to subtle radiographic findings and/or patient unawareness of trauma in the insensate foot. Failure to initiate treatment in the early stages of acute diabetic neuropathic Lisfranc injuries can predispose the patient to midfoot instability, potential ulceration, infection, and Charcot neuroarthropathy.
Surgical Treatment Of Intra-Articular Calcaneal Fractures., John Stapleton, Thomas Zgonis
Surgical Treatment Of Intra-Articular Calcaneal Fractures., John Stapleton, Thomas Zgonis
John J Stapleton DPM, FACFAS
Most intra-articular calcaneal fractures are a result of high-energy trauma. The operative management of calcaneal fractures has been based on achieving anatomic reduction and minimizing complications of the compromised soft tissue envelope. The traditional extensile lateral approach offers advantages of achieving adequate fracture reduction with the risk of wound-healing complications and infection. Limited open reduction and internal fixation techniques with or without using external fixation focuses on achieving fracture reduction with less risk of wound complications but higher risk of malunion. This article discusses key points of operative management for various intra-articular calcaneal fracture patterns and clinical presentations.
Utilizing A Crossover Reverse Sural Artery Flap For Soft Tissue Reconstruction Of The Plantar Forefoot After A Severe Degloving Injury., Thomas Zgonis, Douglas T Cromack, John Stapleton
Utilizing A Crossover Reverse Sural Artery Flap For Soft Tissue Reconstruction Of The Plantar Forefoot After A Severe Degloving Injury., Thomas Zgonis, Douglas T Cromack, John Stapleton
John J Stapleton DPM, FACFAS
Extensive soft tissue defects involving the weight-bearing areas of the plantar aspect of the foot often require coverage with flaps. The options often include free flaps, free muscle flaps with split-thickness skin grafting, or local flaps. When presented with high-energy-induced soft tissue injuries of the foot, choices become narrow, secondary to the associated zone of injury. Free flaps require a viable recipient vessel suitable for microvascular anastomosis. Split-thickness skin grafts applied to the plantar aspect of the foot are prone to persistent breakdown. Local flaps if available are useful for coverage of plantar soft tissue defects. However, when local flaps …
Combined Lateral Column Arthrodesis, Medial Plantar Arteryflap, And Circular External Fixation For Charcot Midfoot Collapse With Chronic Plantar Ulceration., Thomas Zgonis, Thomas S Roukis, John Stapleton, Douglas T Cromack
Combined Lateral Column Arthrodesis, Medial Plantar Arteryflap, And Circular External Fixation For Charcot Midfoot Collapse With Chronic Plantar Ulceration., Thomas Zgonis, Thomas S Roukis, John Stapleton, Douglas T Cromack
John J Stapleton DPM, FACFAS
No abstract provided.
Surgically Induced Charcot Neuroarthropathy Following Partial Forefoot Amputation In Diabetes., T Zgonis, John Stapleton, N Shibuya, T S Roukis
Surgically Induced Charcot Neuroarthropathy Following Partial Forefoot Amputation In Diabetes., T Zgonis, John Stapleton, N Shibuya, T S Roukis
John J Stapleton DPM, FACFAS
No abstract provided.
Revisional Charcot Foot And Ankle Surgery., John Stapleton, Ronald Belczyk, Thomas Zgonis
Revisional Charcot Foot And Ankle Surgery., John Stapleton, Ronald Belczyk, Thomas Zgonis
John J Stapleton DPM, FACFAS
Charcot neuroarthropathy is often a devastating diabetic foot complication that poses a great risk for limb loss and can have a significant impact on a patient's quality of life in the presence of multiple existing comorbidities. It is a progressive and debilitating condition characterized by joint dislocation, pathologic fracture(s), and extensive destruction of the foot or ankle architecture secondary to dense peripheral neuropathy. This pathologic process can be idiopathic, secondary to acute trauma or previous surgery, or attributable to repetitive "microinjury." Once the Charcot process has been initiated, continued ambulation results in progressive collapse and deformity. Severe deformities can have …
Surgical Treatment Of Tibial Plafond Fractures., John Stapleton, Thomas Zgonis
Surgical Treatment Of Tibial Plafond Fractures., John Stapleton, Thomas Zgonis
John J Stapleton DPM, FACFAS
Intra-articular fractures of the tibial plafond are typically the result of rotational or axial loading forces, and both mechanisms of injuries can result in an associated fibula fracture. Rotational distal tibial plafond fractures are typically of lower energy and are associated with less articular injury and chondral impaction, whereas axial load injuries of the distal tibial plafond are associated with a higher incidence of intra-articular and soft tissue injury. The goal of this article is to review the mechanisms of injury, fracture patterns, and potential complications associated with the most common presentations of tibial plafond fractures.
Lower Extremity Complex Trauma And Complications., John Stapleton
Lower Extremity Complex Trauma And Complications., John Stapleton
John J Stapleton DPM, FACFAS
No abstract provided.
A Case Report Of A Double Advancement Flap Closure Combined With An Ilizarov Technique For The Chronic Plantar Forefoot Ulceration., Ronald Belczyk, John Stapleton, Thomas Zgonis
A Case Report Of A Double Advancement Flap Closure Combined With An Ilizarov Technique For The Chronic Plantar Forefoot Ulceration., Ronald Belczyk, John Stapleton, Thomas Zgonis
John J Stapleton DPM, FACFAS
Soft tissue closure of defects on the plantar surface of the foot continues to be a challenge for the reconstructive surgeon secondarily to the limited number of surgical options and often difficulty of replacing durable and similar soft tissue coverage. Primary closure and skin grafting may not be suitable for the weight-bearing surfaces of the plantar forefoot area, and closure may then be obtained by other means of plastic surgery techniques.
Surgical Treatment Of Calcaneal Fracture Malunions And Posttraumatic Deformities., John Stapleton, Ronald Belczyk, Thomas Zgonis
Surgical Treatment Of Calcaneal Fracture Malunions And Posttraumatic Deformities., John Stapleton, Ronald Belczyk, Thomas Zgonis
John J Stapleton DPM, FACFAS
The surgical management of calcaneal fractures presents with several obstacles to the treating physician. Many experienced surgeons acknowledge a steep and significant learning curve in the operative management of calcaneal fractures. Nonoperative management of displaced intra-articular calcaneal fractures may result in malunion, thereby affecting the function of the ankle and subtalar joint. Although some calcaneal fractures can be treated conservatively, a majority of them require operative intervention. The goal of this article is to bring some insight into the realm of revisional surgery on residual deformity of the calcaneus after operative intervention and also provide a rationale approach to successfully …
Surgical Reconstruction Of The Diabetic Charcot Foot: Internal, External Or Combined Fixation?, John Stapleton, Thomas Zgonis
Surgical Reconstruction Of The Diabetic Charcot Foot: Internal, External Or Combined Fixation?, John Stapleton, Thomas Zgonis
John J Stapleton DPM, FACFAS
Charcot neuroarthropathy of the foot and ankle is a devastating neuropathic complication that can eventually lead to a lower extremity amputation in the presence of an ulceration or infection. Current surgical approaches for the management of the diabetic Charcot foot and ankle deformities are largely based on expert opinions in various fixation methods attempting to avoid major postoperative complications. The goal of this article is to discuss the advantages and disadvantages of various internal, external, or combined fixation methods as they relate to the inherent challenges in the management of the diabetic Charcot foot.
Complications And Revisional Hallux Valgus Surgery., Ronald Belczyk, John Stapleton, Jordan P Grossman, Thomas Zgonis
Complications And Revisional Hallux Valgus Surgery., Ronald Belczyk, John Stapleton, Jordan P Grossman, Thomas Zgonis
John J Stapleton DPM, FACFAS
Complications with hallux valgus surgery can manifest in a variety of ways, but ultimately preventing them depends on the surgeon's expertise in patient and procedural selection, ability to perform the surgery selected, and knowledge in dealing with postoperative care and complications if present. In this article, the authors discuss common diagnostic and treatment dilemmas when dealing with recurrent hallux valgus, hallux varus, malunion, and avascular necrosis following bunion surgery.
Management Of Diabetic Neuropathic Foot And Ankle Malunions And Nonunions., John Stapleton
Management Of Diabetic Neuropathic Foot And Ankle Malunions And Nonunions., John Stapleton
John J Stapleton DPM, FACFAS
The management of diabetic neuropathic foot and ankle malunions and/or nonunions is often complicated by the presence of broken or loosened hardware, Charcot joints, infection, osteomyelitis, avascular bone necrosis, unstable deformities, bone loss, disuse and pathologic osteopenia, and ulcerations. The author discusses a rational approach to functional limb salvage with various surgical techniques that are aimed at achieving anatomic alignment, long-term osseous stability, and adequate soft tissue coverage. Emphasis is placed on techniques to overcome the inherent challenges that are encountered when surgically managing a diabetic nonunion and/or malunion. Particular attention is directed to the management of deep infection and …
The Role Of An Extended Medial Column Arthrodesis For Charcot Midfoot Neuroarthropathy., Claire M Capobianco, John Stapleton, Thomas Zgonis
The Role Of An Extended Medial Column Arthrodesis For Charcot Midfoot Neuroarthropathy., Claire M Capobianco, John Stapleton, Thomas Zgonis
John J Stapleton DPM, FACFAS
The etiology of diabetic Charcot neuroarthropathy involving the midfoot often includes an inciting traumatic event or repetitive micro-trauma from an uncompensated biomechanical imbalance that potentiates an incompletely understood pathway leading to a rocker-bottom foot deformity and ulceration. In the setting of a severe Charcot foot fracture and/or dislocation with obvious osseous instability, diagnostic delay can potentiate the limb-threatening sequelae of infected midfoot ulcerations in this patient population. In this article, the authors discuss the thought process as well as the advantages of performing an extended medial column arthrodesis for selected Charcot midfoot deformities.
Supramalleolar Osteotomy And Ankle Arthrodiastasis For Juvenile Posttraumatic Ankle Arthritis., John Stapleton, Thomas Zgonis
Supramalleolar Osteotomy And Ankle Arthrodiastasis For Juvenile Posttraumatic Ankle Arthritis., John Stapleton, Thomas Zgonis
John J Stapleton DPM, FACFAS
Numerous techniques have been described for posttraumatic ankle arthritis with or without an associated lower extremity deformity in the adult population. These surgical procedures may include, but are not limited to, ankle exostectomy with joint resurfacing, ankle arthrodiastasis, ankle arthroplasty, and ankle arthrodesis. Associated deformities may also be addressed with supramalleolar osteotomies, tibia or fibular lengthening, and calcaneal osteotomies. In juvenile patients, surgical treatment options for posttraumatic ankle arthritis can be challenging, especially when an associated deformity is present. This article describes a combined supramalleolar osteotomy and ankle arthrodiastasis for a juvenile patient with posttraumatic ankle arthritis and valgus deformity.
Combined Medial Displacement Calcaneal Osteotomy, Subtalar Joint Arthrodesis, And Ankle Arthrodiastasis For End-Stage Posterior Tibial Tendon Dysfunction., John Stapleton, Ronald Belczyk, Thomas Zgonis, Vasilios D Polyzois
Combined Medial Displacement Calcaneal Osteotomy, Subtalar Joint Arthrodesis, And Ankle Arthrodiastasis For End-Stage Posterior Tibial Tendon Dysfunction., John Stapleton, Ronald Belczyk, Thomas Zgonis, Vasilios D Polyzois
John J Stapleton DPM, FACFAS
Combining an ankle arthrodiastasis with a medial displacement calcaneal osteotomy and a subtalar joint arthrodesis offers surgeons a joint-sparing procedure for young and active patients who have end-stage posterior tibial tendon dysfunction and ankle joint involvement. An isolated subtalar joint arthrodesis or triple arthrodesis combined with an ankle arthrodiastasis is an option that can be used in certain case scenarios. Delaying the need for a joint destructive procedure through an ankle arthrodiastasis, however, may have a great impact in the near future, as advancements are underway to improve the use of ankle endoprosthesis.
Plantar Foot Donor Site As A Harvest Of A Split-Thickness Skin Graft., Ronald Belczyk, John Stapleton, Peter A Blume, Thomas Zgonis
Plantar Foot Donor Site As A Harvest Of A Split-Thickness Skin Graft., Ronald Belczyk, John Stapleton, Peter A Blume, Thomas Zgonis
John J Stapleton DPM, FACFAS
The authors present a minimally invasive procedure for harvesting a split thickness skin graft (STSG) from the plantar surface of the foot. This is another option to consider for soft tissue reconstruction of diabetic foot wounds to help restore form and function and to prevent amputation. The authors do not recommend this technique for all soft tissue wounds of the toes and plantar aspect of the foot but believe it is a viable option for selected small diabetic foot wounds that may benefit from a STSG.
Advanced Foot And Ankle Fixation Techniques In Patients With Diabetes., Nicholas J Bevilacqua, John Stapleton
Advanced Foot And Ankle Fixation Techniques In Patients With Diabetes., Nicholas J Bevilacqua, John Stapleton
John J Stapleton DPM, FACFAS
This article presents advanced techniques and current fixation constructs that are advantageous for the management of diabetic foot and ankle trauma and Charcot neuroarthropathy. Both these pathologies are often intimately related, and the fixation constructs that are required often require sound biomechanical concepts coupled with innovative approaches to achieve bone healing and limb salvage.
Addressing Psychosocial Aspects Of Care For Patients With Diabetes Undergoing Limb Salvage Surgery., Thomas S Roukis, John Stapleton, Thomas Zgonis
Addressing Psychosocial Aspects Of Care For Patients With Diabetes Undergoing Limb Salvage Surgery., Thomas S Roukis, John Stapleton, Thomas Zgonis
John J Stapleton DPM, FACFAS
Surgeons provide a key role in improving the life of patients with diabetes-related foot complications who undergo limb salvage surgery as an alternative to amputation. An integrated multidisciplinary approach is essential to improve the emotional well-being of these patients to avoid potential complications that may prolong their convalescence and further degrade their psychosocial welfare. The authors attempt to increase awareness of critical preoperative risk factors that should be obtained by a thorough comprehensive psychosocial evaluation. In addition, this article discusses how to interact with the patient and his or her family throughout the perioperative period, assisting the patient in managing …