PubMed Health⌕ Search

Biomedical subjects

Thomas Zgonis

Publications and source records attributed to Thomas Zgonis.

30 records · Page 2Linked to original sources
PubMed2003

Diabetic foot infections and antibiotic therapy.

Diabetic foot infections are associated with high morbidity and mortality rates as well as significant financial impact on the health care system. Improved patient outcomes and intelligent use of resources should determine the selection of diagnostic procedures and the therapeutic modalities used. Diabetic patients who develop lower extremity infections require a multidisciplinary approach in the management of their infections and other disorders. Aggressive surgical debridement and appropriate and adequate antibiotic therapy are necessary to successfully treat severe foot infections and permit faster recovery.

Anti-Bacterial Agents↗
PubMed2003

External fixation in the management of Charcot neuroarthropathy.

Charcot neuroarthropathy is a complex sequela of neuropathies associated with diabetes mellitus, syringomyelia, alcoholism, and other disorders. The treatment of deformities associated with Charcot neuroarthropathy is evolving from a passive approach to one in which an earlier recognition of the emergence of the event permits an avoidance of deformity. As the understanding of the etiology and natural history of Charcot neuroarthropathy deepens, it has become apparent that many of the deformities that do develop may be reconstructed expeditiously by the surgeon with a thorough understanding of the diabetic foot and experience in the use of external fixation.

Arthropathy, Neurogenic↗
PubMed2003

Soft tissue reconstruction of the diabetic foot.

Treatment of wounds in the diabetic foot presents a set of difficult problems that requires "out of the box" thinking. The traditional approach of off-loading these wounds is often expensive, time-consuming, and in some cases seemingly never ending. The literature speaks loudly for a change in the philosophy of treating chronic wounds. When developing a team to treat chronic diabetic wounds, a reconstructive foot and ankle surgeon trained in these techniques is an appropriate addition to the team.

Diabetic Foot↗
PubMed2002

Use of the Cobb procedure in the treatment of posterior tibial tendon dysfunction.

Numerous surgical procedures have been described for the treatment of the adult acquired flatfoot deformity. The surgeon should review in detail all the clinical, radiographic and imaging tests and propose the best surgical procedure for the patient. Although flexor tendon transfer has shown excellent results, the split anterior tibial tendon transfer is a second option. If used properly, the Cobb procedure results in less functional loss, since only half of the anterior tibial tendon is transferred. Furthermore, the flexor tendon is not disrupted and continues its primary function in the foot and ankle. Ultimately, the goals of the surgical procedure are to alleviate the patient's symptoms and pain, restore a normal foot alignment, and limit the loss of foot and ankle function without causing any complications.

Foot Diseases↗
PubMedDate not supplied

A systematic approach to diabetic foot infections.

Foot infection is the most common reason for hospitalization and subsequent lower extremity amputation among persons with diabetes. Foot ulceration caused by diabetic neuropathy, trauma, and peripheral vascular disease can lead to a limbor life-threatening infection. The optimum treatment of these potentially devastating conditions depends on a multidisciplinary approach that addresses the related or underlying disorders and thus ensures proper wound healing and a positive outcome. In addition to antibiotic therapy, severe soft-tissue or bone infections may necessitate surgical treatment, including drainage, débridement, and vascular reconstruction. Initial (empiric) antibiotic therapy should provide coverage against staphylococci and streptococci and should be revised according culture results. Antibiotic therapy is not indicated in clinically noninfected wounds. The duration of antibiotic treatment can range from 1 week for mild infections to 6 weeks or more for residual osteomyelitis and severe deep tissue infections. Aggressive (and sometimes repeated or staged) surgical intervention and appropriate antibiotic therapy can reduce the likelihood of a major amputation and the duration of hospitalization.

Anti-Bacterial Agents↗
PubMedDate not supplied

Autologous platelet-rich plasma for wound and osseous healing: a review of the literature and commercially available products.

The application of autologous platelets that have been sequestered, concentrated, and mixed with thrombin to create growth factor-concentrated, autologous platelet-rich plasma for application to soft tissue wounds and for osseous healing has been a subject of great interest for much of the past 2 decades. Autologous platelet-rich plasma, which consists of both quantitative and qualitative components, has the greatest potency or ability to produce the desired effect. Manufacturers prepare autologous platelet-rich plasma with the ultimate goal of maximizing its benefits while minimizing potential risks. Unfortunately, the manufacturing processes for autologous platelet-rich plasma are highly variable, and the types of proprietary systems available on the market for soft tissue and osseous applications are numerous. The authors provide here an in-depth review of commercially available systems for delivery of autologous platelet-rich plasma that emphasizes the subtle yet important differences among systems. In addition, a detailed review of the literature regarding the use of autologous platelet-rich plasma in soft tissue and osseous healing is provided. Although findings are not yet conclusive, autologous platelet-rich plasma has been shown to be safe, reproducible, and effective in mimicking the natural processes of soft tissue wound and osseous healing.

Blood Platelets↗
PubMedDate not supplied

The efficacy of prophylactic intravenous antibiotics in elective foot and ankle surgery.

A retrospective chart review of 555 patients who received elective foot and ankle surgeries between 1995 and 2001 at 1 outpatient podiatric hospital clinic was performed to evaluate the efficacy of preoperative intravenous antibiotic use. Only those patients who were having elective foot or ankle surgery for the first time, were being followed up at the hospital's outpatient clinic, and had a nontraumatic cause for their surgery were included in this study. A wound was considered infected when purulent material from the wound sites was noted and an organism(s) was cultured. A wound complication was defined as a superficial dehiscence, edema, erythema, or stitch abscess. Three hundred six (55.1%) patients received a preoperative antibiotic and 249 (44.9%) patients did not. Of the 306 patients who received a preoperative antibiotic, 9 (1.6%) acquired a postoperative wound infection, whereas 8 (1.4%) of the 249 patients who did not receive preoperative antibiotics acquired a postoperative infection. A logistic regression model and chi square tests of association were used to determine if preoperative antibiotic use, age, gender, type of surgical procedure, operative time, tourniquet use, past medical history, and internal fixation were predictive of or associated with postoperative wound infection or complication. None of the study factors was predictive of postoperative wound infection or complication (P >.01). Preoperative antibiotic use was associated with surgical category and internal fixation use (P <.001) but not postoperative wound infection or complication (P >.01). The results suggest that prophylactic intravenous antibiotic use in routine elective foot and ankle surgery is not warranted.

Adult↗
PubMedDate not supplied

The value of radiographic parameters in the surgical treatment of hallux rigidus.

The purpose of this study was to determine if metatarsal protrusion or the length of the first and second rays were associated with the incidence of hallux rigidus. For this retrospective study, anteroposterior radiographs from 51 patients diagnosed with hallux rigidus and 51 patients without evidence of hallux rigidus were selected for review as a control group. Radiographs were randomly assigned to one of two raters who determined the metatarsal protrusion distance, first metatarsal length, second metatarsal length, length of the proximal phalanx of the hallux, length of the proximal phalanx of the second toe, and overall hallux length. A statistical comparison of these radiographic measurements showed only first metatarsal length to significantly differ (P = .05) between the two groups (65.4 +/- 5.3 mm and 67.7 +/- 5.9 mm for the hallux rigidus and control groups, respectively). The findings of this study suggest the need to revisit the role that metatarsal protrusion distance and first metatarsal length play in the etiology of hallux rigidus. In addition the need to surgically correct a long first metatarsal should be further evaluated.

Cross-Sectional Studies↗
PubMedDate not supplied

A retrospective study of patients with diabetes mellitus after partial foot amputation and hyperbaric oxygen treatment.

A retrospective chart review was conducted of 35 patients (40 feet) who received hyperbaric oxygen (HBO) therapy after partial foot amputation between 1990 and 2000. Preoperative transcutaneous partial pressure of oxygen (tcPO2) levels, the number of hyperbaric treatments, time to final outcome, use of revascularization procedures, and postsurgical outcome were extracted from the charts. Seventy percent (n = 28) had a successful outcome, defined as complete healing and absence of ulceration at the amputation site, and lack of further surgical procedures to heal the amputation site; whereas 30% (n = 12) had a failed outcome, defined as lack of healing or the presence of an ulcer at the site of amputation or the need for further surgery to heal the amputation site. The level of amputation, use of revascularization procedures, time to final outcome, and number of hyperbaric treatments were not significantly different (P > .05) between the 2 postsurgical outcome groups. The mean preoperative tcPO2 levels were greater (P < .01) in the successful (24 +/- mm Hg) than in the failed (11 +/- mm Hg) outcome groups. All patients with a tcPO2 level > 29 mm Hg had a successful outcome. Patients with a successful postsurgical outcome had a mean of 20 HBO treatments and took 44 days to final outcome, while those with a failed postsurgical outcome had 16 HBO treatments and took 216 days to final outcome.

Amputation, Surgical↗
PubMedDate not supplied

Necrotizing fasciitis in a patient with type 2 diabetes mellitus.

Necrotizing fasciitis is a soft-tissue infection characterized by extensive necrosis of subcutaneous fat, neurovascular structures, and fascia. In general, fascial necrosis precedes muscle and skin involvement, hence its namesake. Initially, this uncommon and rapidly progressive disease process can present as a form of cellulitis or superficial abscess. However, the high morbidity and mortality rates associated with necrotizing fasciitis suggest a more serious, ominous condition. A delay in diagnosis can result in progressive advancement highlighted by widespread infection, multiple-organ involvement, and, ultimately, death. We present a case of limb salvage in a 52-year-old patient with type 2 diabetes mellitus and progressive fascial necrosis. A detailed review of the literature is presented, and current treatment modalities are described. Aggressive surgical debridement, comprehensive medical management of the sepsis and comorbidities, and timely closure of the resultant wound or wounds are essential for a successful outcome.

Debridement↗