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Full-Text Articles in Medicine and Health Sciences

A Pilot Study Investigating The Utilization Of Crest Pads For Treatment Of Toe Callus And Ulceration (Presentation), Monica L. Melo Dnp, Rn, Acns-Bc, Cwocn, Cfcn, James Mccullough Md, Tricia S. Bernecker Phd, Msn, Rn, Acns-Bc, John J. Hong Md, Jane Scott Trumbauer Oct 2015

A Pilot Study Investigating The Utilization Of Crest Pads For Treatment Of Toe Callus And Ulceration (Presentation), Monica L. Melo Dnp, Rn, Acns-Bc, Cwocn, Cfcn, James Mccullough Md, Tricia S. Bernecker Phd, Msn, Rn, Acns-Bc, John J. Hong Md, Jane Scott Trumbauer

Patient Care Services / Nursing

No abstract provided.


Local And Distant Pedicle Flaps For Soft Tissue Reconstruction Of The Diabetic Foot: A Stepwise Approach With The Use Of External Fixation, T. Zgonis, John Stapleton, I. Papakostas Feb 2015

Local And Distant Pedicle Flaps For Soft Tissue Reconstruction Of The Diabetic Foot: A Stepwise Approach With The Use Of External Fixation, T. Zgonis, John Stapleton, I. Papakostas

John J Stapleton DPM, FACFAS

No abstract provided.


Stepwise Approach To Static Circular External Fixation, John Stapleton, V. Polyzois, T. Zgonis Feb 2015

Stepwise Approach To Static Circular External Fixation, John Stapleton, V. Polyzois, T. Zgonis

John J Stapleton DPM, FACFAS

No abstract provided.


Use Of Circular External Fixation For Combined Subtalar Joint Fusion And Ankle Distraction., Thomas Zgonis, John Stapleton, Thomas S Roukis Feb 2015

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 Feb 2015

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 Feb 2015

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 …


Stepwise Approach To Ankle/Pilon Trauma And External Fixation, John Stapleton, V. Polyzois, T. Zgonis Feb 2015

Stepwise Approach To Ankle/Pilon Trauma And External Fixation, John Stapleton, V. Polyzois, T. Zgonis

John J Stapleton DPM, FACFAS

No abstract provided.


Negative-Pressure Wound Therapy In The Management Of Diabetic Charcot Foot And Ankle Wounds., Crystal L Ramanujam, John Stapleton, Thomas Zgonis Feb 2015

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.


The Diabetic Foot, C. Ramanujam, John Stapleton, T. Zgonis Feb 2015

The Diabetic Foot, C. Ramanujam, John Stapleton, T. Zgonis

John J Stapleton DPM, FACFAS

No abstract provided.


Revisional And Reconstructive Surgery Of The Diabetic Foot And Ankle, T. Zgonis, John Stapleton, V. Polyzois, E. Sella Feb 2015

Revisional And Reconstructive Surgery Of The Diabetic Foot And Ankle, T. Zgonis, John Stapleton, V. Polyzois, E. Sella

John J Stapleton DPM, FACFAS

No abstract provided.


Internal And External Fixation Approaches To The Surgical Management Of Calcaneal Fractures., John Stapleton, Gennady Kolodenker, Thomas Zgonis Feb 2015

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.


Surgical Management Of Diabetic Charcot Foot And Ankle Deformities, John Stapleton, Zacharia Facaros, Vasilios Polyzois, Thomas Zgonis Feb 2015

Surgical Management Of Diabetic Charcot Foot And Ankle Deformities, John Stapleton, Zacharia Facaros, Vasilios Polyzois, 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 Feb 2015

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 Feb 2015

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.


Stepwise Approach To Forefoot Trauma And External Fixation, C. Capobianco, John Stapleton, T. Zgonis Feb 2015

Stepwise Approach To Forefoot Trauma And External Fixation, C. Capobianco, John Stapleton, T. Zgonis

John J Stapleton DPM, FACFAS

No abstract provided.


Stepwise Approach To Midfoot/ Hindfoot Trauma And External Fixation, John Stapleton, V. Polyzois, T. Zgonis Feb 2015

Stepwise Approach To Midfoot/ Hindfoot Trauma And External Fixation, John Stapleton, V. Polyzois, T. Zgonis

John J Stapleton DPM, FACFAS

No abstract provided.


Stepwise Approach To Adult And Pediatric Foot And Ankle Malunions/Nonunions And External Fixation, A. Cherkashin, M. Samchukov, J. Birch, John Stapleton, T. Zgonis Feb 2015

Stepwise Approach To Adult And Pediatric Foot And Ankle Malunions/Nonunions And External Fixation, A. Cherkashin, M. Samchukov, J. Birch, John Stapleton, T. Zgonis

John J Stapleton DPM, FACFAS

No abstract provided.


Current Concepts With External Fixation And The Charcot Foot, Crystal Ramanujam, John Stapleton, Thomas Zgonis Feb 2015

Current Concepts With External Fixation And The Charcot Foot, Crystal Ramanujam, John Stapleton, Thomas Zgonis

John J Stapleton DPM, FACFAS

No abstract provided.


Charcot Foot: New Treatments, Better Outcomes, Thomas Zgonis, T. Roukis, John Stapleton, D. Cromack Feb 2015

Charcot Foot: New Treatments, Better Outcomes, Thomas Zgonis, T. Roukis, John Stapleton, D. Cromack

John J Stapleton DPM, FACFAS

No abstract provided.


Diabetic Foot Infections: A Team-Oriented Review Of Medical And Surgical Management., Claire M Capobianco, John Stapleton Feb 2015

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 Feb 2015

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 Feb 2015

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 Feb 2015

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 …


Stepwise Approach To Midfoot And Hindfoot Elective And Reconstructive Surgery With External Fixation, John Stapleton, T. Zgonis Feb 2015

Stepwise Approach To Midfoot And Hindfoot Elective And Reconstructive Surgery With External Fixation, John Stapleton, T. Zgonis

John J Stapleton DPM, FACFAS

No abstract provided.


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 Feb 2015

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 Feb 2015

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 Feb 2015

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 Feb 2015

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.


Pertinent Insights On Plastic Surgery And The Diabetic Foot, Z. Facaros, Crystal Ramanujam, John Stapleton, Thomas Zgonis Feb 2015

Pertinent Insights On Plastic Surgery And The Diabetic Foot, Z. Facaros, Crystal Ramanujam, John Stapleton, Thomas Zgonis

John J Stapleton DPM, FACFAS

No abstract provided.


Use Of The Taylor Spatial Frame For Arthrodiastasis Of The Ankle Joint, Thomas Zgonis, John Stapleton, T. Roukis Feb 2015

Use Of The Taylor Spatial Frame For Arthrodiastasis Of The Ankle Joint, Thomas Zgonis, John Stapleton, T. Roukis

John J Stapleton DPM, FACFAS

No abstract provided.