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Lawrence A Lavery

Publications and source records attributed to Lawrence A Lavery.

29 records · Page 2Linked to original sources
PubMed2002

Ankle equinus deformity and its relationship to high plantar pressure in a large population with diabetes mellitus.

The authors undertook a study to evaluate the prevalence of ankle equinus and its potential relationship to high plantar pressure in a large, urban population with diabetes mellitus. The first 1,666 consecutive people with diabetes (50.3% male; mean [+/-SD] age, 69.1 +/- 11.1 years) presenting to a large, urban, managed-care outpatient clinic were enrolled in this longitudinal, 2-year outcomes study. Patients received a standardized medical and musculoskeletal assessment at the time of enrollment, including evaluation at an onsite gait laboratory. Equinus was defined as less than 0 degrees of dorsiflexion at the ankle. The overall prevalence of equinus in this population was 10.3%. Patients with equinus had significantly higher peak plantar pressures than those without the deformity and were at nearly three times greater risk for presenting with elevated plantar pressures. There were no significant differences in age, weight, or sex between the two groups. However, patients with equinus had a significantly longer duration of diabetes than those without equinus. Having a high index of suspicion for this deformity and subsequently addressing it through conservative or surgical means may help to reduce the risk of foot ulceration and amputation.

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PubMed2002

Outcomes of subatmospheric pressure dressing therapy on wounds of the diabetic foot.

The purpose of this retrospective study was to evaluate outcomes of people with large diabetic foot wounds treated with subatmospheric pressure dressing therapy immediately following surgical wound debridement. Data were abstracted from the medical records of 31 consecutive patients with diabetes, 77.4% male (n = 24), aged 56.1 +/- 11.7 years, presenting for care at two large multidisciplinary wound care centers. All patients received surgical debridement for indolent diabetic foot wounds and were subsequently started on a regimen of subatmospheric pressure dressing therapy delivered using a vacuum-assisted closure device for a mean of 4.7 +/- 4.2 weeks (mode = 2 weeks) using a protocol that called for cessation of therapy when the wound bed approached 100% coverage with granulation tissue with no exposed tendon, joint capsule, or bone. Outcomes evaluated included time to complete wound closure, proportion of patients achieving wound healing at the level of initial debridement, and complications associated with use of the device. The mean duration of wounds before therapy was 25.4 +/- 23.8 weeks. In patients treated with subatmospheric pressure dressing therapy, 90.3% (n = 28) of wounds healed at the level of debridement without the need for further bony resection in a mean 8.1 +/- 5.5 weeks. The remaining 9.7% (n = 3) went on to higher level amputation (below knee amputation = 3.2%, [n = 1] and transmetatarsal amputation = 6.5% [n = 2]). Complications included periwound maceration (19.4% [n = 6]), periwound cellulitis (3.2% [n = 1]), and deep space infection (3.2% [n = 1]). The authors concluded that appropriate use of subatmospheric pressure dressing therapy to achieve a rapid granular bed in diabetic foot wounds may have promise in treatment of this population at high risk for amputation and that a large, randomized trial is now indicated.

Atmospheric Pressure↗
PubMedDate not supplied

Diabetic lower extremity infection: influence of physical, psychological, and social factors.

AIMS: Although literature is scarce, it is a common belief that patients with lower social background are more prone to diabetic complications. The purpose of this study was to identify local, systemic, and psychosocial risk factors that can lead to severe foot infections and subsequent amputations. METHODS: This study was set up as a case-control study. We enrolled 112 persons with diabetes, in an approximately 1:1 case to control ratio. Cases were defined as patients admitted to the hospital with a severe foot infection, possibly necessitating a lower extremity amputation; controls were patients admitted for nonemergent medical or surgical cause. Study participants received a physical examination and interview to evaluate exposure variables, including demographic data, general medical, surgical, diabetes, and diabetes-related complication history. Socioeconomic status was quantified with the Duncan socioeconomic impact and Siegel prestige score. The patient's knowledge of foot care was evaluated as well. The risks for severe foot infection of social, economical, and physical risk factors were compared in a stepwise logistic regression analysis. RESULTS: The following variables were significant factors for severe foot infection: history of previous amputation [odds ratio (OR)=19.9, P=.01], peripheral vascular disease (OR=5.5, P=.007), and peripheral neuropathy, as measured with vibratory perception threshold (OR 3.4, P=.044). Social and economic factors were not significant in this model. CONCLUSIONS: These data suggest that physical risk factors are important in foot infection and that the additional risk of socioeconomic status or knowledge of foot care is limited in this population.

Amputation, Surgical↗
PubMedDate not supplied

Reproducibility of gait analysis variables: one-step versus three-step method of data acquisition.

The purpose of the study was to evaluate the preciseness and repeatability of EMED-SF platform data collection using two different protocols. Gait variables of five healthy women and five men, with an average age of 27.3 +/- 3.2 years, weighing 67.5 +/- 13.3 kg, were evaluated. With a one-step and a three-step approach of data collection, peak pressure, pressure-time integral, and contact time were measured. Peak pressures were not significantly different between both methods. Significant differences were found between both methods in total contact time and pressure-time integral. Both methods were comparable in peak pressures (error between methods = 7.0), while the one-step protocol was more repeatable (intraclass correlation coefficient = 0.59) than the three-step protocol (intraclass correlation coefficient = 0.36). The error between methods for total contact time and pressure-time integral were 143.3 and 50.1, respectively, suggesting that the two protocols lead to different results. The one-step protocol (intraclass correlation coefficient = 0.40) had a higher repeatability than the three-step protocol (intraclass correlation coefficient = 0.31). The one-step protocol has some advantages over the three-step protocol as far as repeatability, simplicity, convenience, and time conservation are concerned. For measuring total contact time and pressure-time integrals, both methods have comparable repeatability, although the protocols lead to different outcomes.

Adult↗
PubMedDate not supplied

Use of subatmospheric (VAC) therapy to improve bioengineered tissue grafting in diabetic foot wounds.

The use of bioengineered tissue and topical subatmospheric pressure therapy have both been widely accepted as adjunctive therapies for the treatment of noninfected, nonischemic diabetic foot wounds. This article describes a temporally overlapping method of care that includes a period of simultaneous application of bioengineered tissue (Apligraf, Novartis Pharmaceuticals Corp, East Hanover, New Jersey) and subatmospheric pressure therapy delivered through the VAC (Vacuum Assisted Closure) system (KCI, Inc, San Antonio, Texas). Future descriptive and analytic works may test the hypothesis that combined therapies used at different and often overlapping periods during the wound-healing cycle may be more effective than a single modality.

Bandages↗
PubMedDate not supplied

How and why to surgically debride neuropathic diabetic foot wounds.

Wound debridement, when systematically performed, may be as important as off-loading in reducing the prevalence of chronic inflammatory by-products in a wound and thus in converting a chronic wound into an acute one. Although it has been suggested that aggressive surgical debridement of wounds may be beneficial, there have been few, if any, technical descriptions of this aspect of therapy. It is therefore the purpose of this article to describe the general principles, process, and technique of outpatient surgical debridement of noninfected, nonischemic neuropathic diabetic foot wounds performed at the authors' institutions. The authors hope to foster further discussion leading to improvement in the process and the prevalence of such debridement.

Debridement↗
PubMedDate not supplied

2003 William J. Stickel Silver Award. Skin temperatures as a one-time screening tool do not predict future diabetic foot complications.

This prospective longitudinal study assessed whether baseline mean skin temperature measurements are useful in predicting the most common foot-related complications of diabetes mellitus. We evaluated the mean of baseline skin temperatures taken bilaterally from six plantar sites in 1,588 patients with diabetes. There was no difference in skin temperature based on neuropathy, foot laterality, or foot risk category or between people with and without foot deformity and elevated plantar foot pressure. Whereas people with Charcot's arthropathy had slightly but significantly higher mean temperatures (84.8 degrees +/- 3.5 degrees F versus 82.5 degrees +/- 4.7 degrees F), this was not true for those who developed ulcers or infections or who underwent amputations. The presence of vascular disease was not associated with lower skin temperatures. Mexican Americans (83.0 degrees +/- 4.6 degrees F) and blacks (83.6 degrees +/- 4.5 degrees F) had higher mean skin temperatures at baseline than did non-Hispanic whites (81.8 degrees +/- 4.6 degrees F). Baseline measurement of nonfocal mean skin temperatures is not an effective means of screening people for future events. Regular assessment of skin temperatures, using the contralateral site as a physiologic control, may be a better use of this technology.

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