Biomedical subjects

V J Mandracchia

Publications and source records attributed to V J Mandracchia.

At least 19 recordsLinked to original sources

PubMed2001

Wound healing.

Wounds and wound healing have been studied in the medical arena for centuries, however, in recent decades new advances have emerged in this extensive field. Currently, the wound healing process is studied at the molecular level giving new insights to the physiological process of wound closure and the lack thereof. With development of new treatment modalities the potential for earlier wound closure and ultimately increased quality of life for chronic wound patients is emerging. As understanding of the delicate balance of molecules within the wound increases, options for treating patients will also increase. Again, an understanding of the wound healing process is vital not only when employing these new treatment options, but also for proper patient care.

Chronic Disease↗

PubMed2001

Full-thickness burn of the foot: successful treatment with Apligraf. A case report.

Burn wounds, although uncommon in the foot, present a uniquely challenging opportunity to physicians. The keys to successful management include a proper and specific initial evaluation of the burning agent, the location, the TBSA affected, and the depth. Ultimately, proper recognition and meticulous wound care with skin grafting, when necessary, bring about the desired results. A case report of a patient with a third-degree burn over the dorsum of the left foot is presented. This case is unique in that Apligraf, a human skin equivalent, was used to gain coverage and eventual resolution of the wound. It is the authors' opinion that the use of Apligraf in this application is a viable alternative to traditional methods of skin harvesting and grafting. To the authors' knowledge, there have been no other cases reported of Apligraf use in burn wound coverage of the foot.

Adult↗

PubMed2001

The use of becaplermin (rhPDGF-BB) gel for chronic nonhealing ulcers. A retrospective analysis.

Chronic, nonhealing wounds have plagued health care practitioners for decades. New research and technology have allowed the wound healing process to be understood at a cellular and molecular level, including the vital role of growth factors. This article discusses the effects of platelet-derived growth factor-BB (PDGF-BB) on the wound healing process, emphasizing the inflammatory stage of wound healing and principles of wound care. Preclinical and clinical studies evaluating recombinant human PDGF-BB (rhPDGF-BB) (becaplermin gel) also are discussed. Lastly, the results of a retrospective analysis evaluating the use of rhPDGF-BB at Broadlawns Medical Center (Des Moines, IA) are presented.

Adult↗

PubMed2001

Current concepts of bone healing.

The intent of this article is to present the current understanding of fracture repair and offer investigative evidence to the use of exogenous growth factors enhancing fracture healing. The authors believe that exogenous growth factors have tremendous clinical applications and will continue to influence bone healing in the future. With the expanding knowledge of the intricate molecular and cellular biology of fracture repair being realized, surgeons will be able to enhance and ensure healing of surgical osteotomies, fractured bone ends, or delayed unions. This field of medicine is continuously growing and the possibilities seem endless.

Animals↗

PubMed2001

The use of cancellous screws as an alternative in plate fixation of fibular fractures.

Altering standard AO/ASIF techniques when performing open reduction with internal fixation of fibular fractures by using cancellous screws in place of cortical screws appears to be a viable option. By eliminating a few steps in screw application, the additive effect can lead to a significant decrease in operative and tourniquet time. Close inspection of hardware postoperatively has failed to show any signs of screw loosening or delay in fracture healing. In those cases when hardware has had to be removed, it was noted that screw tightness had not been altered. This topic has been anecdotally discussed within our institution and will be the subject of future scientific investigation. The authors feel that the application of fibular plates with cancellous screws is an acceptable alternative to standard orthopedic technique. Although we do not routinely vary from standard AO/ASIF technique, we feel this particular alteration does not affect outcome other than reducing surgical and tourniquet time, therefore reducing the surgical risks.

Bone Screws↗

PubMed2000

Vancomycin-resistant Enterococci infected puncture wound to the foot. A case report.

Vancomycin is often administered empirically to patients with osteomyelitis, septic arthritis, septic throbophlebitis, infected burns, and cellulitis of the lower extremities when methicillin-resistant staphylococci are suspected, or when a staphylococcus organism is suspected in a penicillin-allergic patient. Physicians must be aware of the guidelines established regarding the use of Vancomycin to avoid bacterial resistance. Physicians also must be aware of the procedures that have been developed to help contain nasocomial outbreaks of Vancomycin-resistant Enterococci.

Adult↗

PubMed2000

Nerve injury associated with plantarflexion-inversion ankle sprains.

This article presents some of the less frequently described nerve pathologies associated with severe plantarflexion-inversion ankle sprains. It outlines the likely mechanisms of nerve injury, the typical presentations, and treatment possibilities. An anatomic review of the lower extremity, with emphasis on the neurologic structures, is also included to assist in understanding the mechanism and location of the nerve injury.

Ankle Injuries↗

PubMed2000

Pentoxifylline. Adjunctive therapy in the treatment of pedal frostbite.

Frostbite injury to the extremities has the potential for disastrous effects. Prompt recognition and treatment are paramount. The use of Pentoxifylline to minimize tissue damage in the treatment of frostbite is a viable addition to the traditional therapy of rewarming soaks, pain management, and vesicle débridement. The most well known action of Pentoxifylline is its ability to increase RBC flexibility, allowing easier vascularization. This explains its indication for PVD, arterial disease, and intermittent claudication. As is explained previously, however, Pentoxifylline has multiple actions that will enhance tissue survival. The dosage of Pentoxifylline in controlled release tablet form is one 400 mg tablet three times a day with meals. The duration of treatment should be from two to six weeks. As this drug has many actions and therefore possibilities, more research is warranted with regards to its use not only with frostbite, but with other pathological processes.

Acute Disease↗

PubMed2000

Tendon pathology in the foot. The use of corticosteroid injection therapy.

Corticosteroids have been used extensively in the practice of orthopedics and podiatry. It is the authors' opinion that the issue of corticosteroids and their effect on the healing of tendon pathology has not been addressed sufficiently or answered adequately. Few studies have used a well-controlled injury model. Steroid dosage and steroid selection also appear to be random. Clinical experience in conjunction with a complete review of the literature, however, leads the authors to believe that the use of local corticosteroid injection is a valid treatment option. Local injection for painful tendon pathology is a relatively simple, safe, and effective form of treatment. The patient may experience rapid relief of pain and swelling and, on occasion, may be able to return to normal activities after one injection. With the exception of the Achilles' tendon, it is the authors' opinion that the use of local corticosteroid injection for the treatment of tendonopathy is not only an option, but an effective means of therapy. Armed with a good understanding of tendon anatomy, proper injection technique, and differing types of corticosteroids, effective results are well within reach for the patient and physician. Unlike nonsteroidal anti-inflammatory drugs (NSAIDs) or oral corticosteroids, injectable corticosteroids deal with the problem at the site, delivering needed relief while eliminating adverse systemic effects. This therapy is cost effective and has fewer potential complications than operative intervention.

Adrenal Cortex Hormones↗

PubMed1999

Evaluation and surgical management of the arthritic midfoot secondary to rheumatic disease.

RA is a common disorder that has significant destructive effects on the midfoot portion of the foot. When these degenerative joint changes occur, any motion at the involved joints causes severe pain and disability, and limits the patient in his or her attempt to perform daily activities. These changes have a significant social and economic impact, and cause unwanted lifestyle changes. Arthrodesis, when used judiciously, can offer pain relief and a restoration of normal activity for the patient with RA.

Arthritis, Rheumatoid↗

PubMed1999

Gunshot wounds to the lower extremity. A comprehensive review.

A thorough knowledge of the mechanisms by which penetrating projectiles disrupt tissue can assist the physician in evaluating and treating the wound in a rational manner. Projectile mass, velocity, shape, construction, and the characteristics and anatomic constraints of the tissue penetrated determine the amount, type, and location of tissue disruption. The possibility of additional injuries caused by secondary missiles and cavitation must be understood to distinguish between conservative versus surgical care of the patient. Adherence to the principles of treatment discussed aids the physician in judgment when treating gunshot wound victims. Furthermore, the authors present a classification system to facilitate the identification and treatment of lower-extremity gunshot wounds. Regardless of the expertise in understanding wound ballistics, the unknown and unexpected variables create a challenge in treating the gunshot victim. A surgeon who believes in wide excision of tissue from all sides of the wound path in any high-velocity wound probably does more harm than that done by the bullet alone. A surgeon treating gunshot wound victims should follow the dictum: "Treat the wound, not the weapon."

Anti-Bacterial Agents↗

PubMed1999

A new fixation technique for metatarsal fractures.

Intramedullary nail fixation is an excellent option for open reduction and internal fixation of metatarsal neck and shaft fractures. In the authors' experience, the reduction of these fractures with Steinmann pin fixation provided excellent stability, required minimal soft-tissue dissection, and allowed for preservation of the periosteal tissue. Minimal disruption to the periosteum protects the osteoprogenitor cells located in the cambium layer. These cells stimulate osteoblastic activity, allowing for excellent secondary bone healing. Intramedullary nail fixation is the authors' chosen procedure for reduction of lesser metatarsal fractures.

Biomechanical Phenomena↗

PubMed1999

Malleolar fractures of the ankle. A comprehensive review.

Ankle injuries and associated malleolar fractures are common. The outcome of treatment depends on the treating physician's ability to properly identify the mechanism of injury and subsequently restore ankle function by accurate realignment of the normal ankle articulations. Particular attention must be paid to restoring the length and alignment of the fibula because it plays a major role in stabilizing the talar ankle component. The medial aspect of the ankle also is important. The vital role of the deltoid has been proved in many studies, and although controversy exists in the proper treatment of this complex, there is agreement regarding the importance of at least identification of medial injury. Malleolar fractures of the ankle have varied presentations. They can range from an isolated fibular fracture with no displacement to a trimalleolar injury with dislocation and vascular compromise. A broad understanding of all aspects of pathoanatomy and treatment options, coupled with training experience, is required before any attempt should be made to treat these injuries. With a thorough understanding of injury patterns and proper fixation techniques, repair of the damaged ankle joint can lead to rewarding outcomes for the patient and physician.

Ankle↗

PubMed1999

Osteochondral lesions of the talar dome. A comprehensive review with retrospective study.

The incidence of osteochondral lesions of the talus is increasing because of a greater awareness of this injury following ankle trauma. The treating physician should view the so-called simple ankle sprain as a potential for fractures of the talar dome, especially in patients who are recalcitrant to treatment. It has been the authors' experience that talar dome lesions respond well to arthrotomy with removal of the fracture fragment and subchondral drilling, and yield generally good results. A high index of suspicion following ankle trauma allows for the early recognition and treatment of talar dome lesions.

Ankle Injuries↗

PubMed1999

Pilon fractures of the distal tibia.

Pilon fractures are one of the most complicated injuries confronting the lower extremity traumatologist. When faced with the pilon fracture, the surgeon must adhere to the principles of anatomic reduction and rigid stabilization to achieve early range of motion. Open reduction and internal or external fixation or a combination of fixation techniques, expertly placed, ensure the best possible outcome with the least complications. A functional lower extremity following a pilon fracture is possible with meticulous evaluation and repair.

External Fixators↗

PubMed1999

Calcaneal fractures.

Proper treatment of calcaneal fractures requires complete knowledge of pathoanatomy, surgical experience, and an understanding of all possible complications; otherwise, a devastating disability will occur. Lowery and Calhoun stated, "Indeed, poor reduction may be worse than no reduction."

Arthritis↗

PubMed1999

Physeal fractures of the ankle.

Because the distal tibia is the third most common physeal injury, being able to assess and treat such a fracture accurately is a skill worth enhancing. Many factors contribute to the outcome of physeal injuries, but the physician's general knowledge of the physis, ability to order the right diagnostic tests, and classify the fracture can be the determining factors of quality care.

Adolescent↗

PubMed1996

Study of ten anatomical variants of the foot and ankle.

This study examined the occurrence rate of ten lower extremity anatomical variants occurring over a 6-year period from 1988 to 1994 in a sample range of 166 to 279 cadavers at the University of Osteopathic Medicine and Health Sciences. Literature review of these anomalies shows similar findings for all presented structures with the exception of two. The peroneus quartus muscle was found to be significantly less prevalent than previous studies have indicated. This difference may be attributed to the larger sample size used in this study or differences of interpretation of the definition of the peroneus quartus muscle. Additionally, the flexor digitorum brevis tendon to the fifth digit was found to be absent much more than Sarrafian reports in a total sample size of 926. The importance of these anatomical variants, both in surgery and while using advanced diagnostic imaging such as computed tomography and magnetic resonance imaging, should be realized by the podiatric physician. Awareness of these variants will decrease confusion when considering treatment options.

Ankle↗