Biomedical subjects
Publications and source records attributed to R T Bouché.
This article comprehensively discusses the authors' preferred technique for first metatarsophalangeal joint arthrodesis in active patients. Included are sections on history of the procedure, procedure rationale, step-by-step description of the authors' technique, pre and postoperative considerations, representative case studies with accompanying comments, and discussion of critical issues.
The author provides a comprehensive review of clubbing deformity and its clinical manifestations after total nail procedures of the hallux. Conservative and surgical treatment is presented with a distal skin plasty procedure described in detail.
The authors provide a detailed description of effective surgical techniques for painful plantar skin lesions of the foot that are not amenable to simple excisional procedures. Modified unilobed and bilobed skin flaps are described, emphasizing step-by-step design and procedure performance. These advanced techniques offer numerous advantages over other excisional and flap methods, such as being reproducible and yielding predictable results.
Chronic compartment syndrome is an uncommon but important cause of exercise-induced leg pain. The author provides a comprehensive review of chronic compartment syndrome of the leg. Case reports are presented to stress the clinical importance of chronic compartment syndrome to the podiatric physician.
An established technique for matricectomy procedures has been described with the effects of negative galvanic current on tissue being elucidated. An ongoing prospective study is in progress to verify previous claims. This procedure appears to offer distinct advantages over conventional procedures and now appropriate instrumentation is readily available, being manufactured specifically for this technique.
The patient, a 16-year-old female, was suffering from an acutely painful right leg and thigh. Tests revealed deep vein thrombosis with pulmonary embolism, resulting from oral contraceptives. She was placed on anticoagulant therapy for a period of time and was discharged from the hospital 9 days after admission.
The modified Lapidus procedure has been used for treatment of hallux abducto valgus for many years, yet only a handful of reports evaluate procedure outcome. The purpose of this investigation was twofold: 1) to provide a retrospective outcome analysis of the modified Lapidus procedure using subjective and objective criteria, and 2) to evaluate procedure outcome in patient populations with differing functional demands: athletes, active patients, and sedentary patients. Thirty-four patients (42 feet) had the modified Lapidus procedure performed by the senior author (R.T.B.) over a 7-year period. Nine patients were lost to follow-up leaving 25 patients (32 feet) for study inclusion. Twenty-three females and two males with average age 44.4 years (range 15-71 years) were evaluated at an average follow-up time of 39 months (range 13-91 months). Evaluation consisted of subjective questionnaire, physical examination, and radiographic assessment. Subjective evaluation revealed that 78% of patients rated surgery "completely" or "very" effective. Athletes demonstrated lower return to preoperative activity levels (30%) than did active patients (86%) and sedentary patients (75%), but this was not statistically significant. Seventy-seven percent of athletes rated surgery "completely" or "very" effective. Postoperative intermetatarsal angle averaged 8.2 degrees (range -2 to 15) and first metatarsophalangeal joint dorsiflexion averaged 62.6 degrees (range 20- 90 degrees). Intermetatarsal angle correction to 10 degrees or less and postoperative first metatarso-phalangeal joint dorsiflexion 45 degrees or greater correlated with improved subjective results. The modified Lapidus procedure is an effective procedure in patients with hypermobility of the first metatarsocuneiform joint. Success is dependent on patient selection, meticulous surgical technique and comprehensive postoperative management.
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Three cases of traumatically induced inclusion cyst affecting the dorsal aspect of the first metatarsophalangeal joint are presented. Though each case was unique, the clinical presentation was similar with patients relating discrete callus formation with a central sinus overlying an enlarging mass. In all cases, the lesion site involved the dorsal first metatarsophalangeal joint and specifically corresponded to the throatline of "pump" shoes that these patients commonly wore. Predisposing factors in these cases appeared to be forefoot equinus deformity with extensus contractor of the extensor hallucis longus tendon and use of pump shoes with a constricting throatline. The authors describe a surgical approach for treatment of this condition, which addresses underlying etiologies of inclusion cyst formation. Pathology was consistent with traumatically induced inclusion cyst. Though inclusion cysts are common in the foot, rarely is the dorsum of the foot involved, and this article, to the authors' knowledge, is the first to be reported in the podiatric literature.